Child Health, 2021

D A R T M O U T H HI T C H C O C K G E I S E L S C H O L O F M E D I C I N E

Child

HEALTH H E L P ING C H I L DR EN LI VE THEIR H AP P IEST, HE ALTH IEST L I V ES

2021

SPECIAL EDITION

GIVING IN ACTION

At-a-Glance

95,000

247

children served each year, including 322,042 outpatient visits

CHaD providers in 30 specialties

30-bed

2,475

neonatal intensive care unit

surgical cases, and 3,598 hospital stays

12

locations, including Dartmouth-Hitchcock Medical Center in Lebanon, N.H.

23-bed

pediatric and adolescent progressive care unit, including pediatric intensive care

2 A Lifeline for Newborns in Need: TeleICN

6 Helping Children with PANS

8 Five Ways that CHaD Cares for the Whole Child

9 CHaD in Manchester: World-Class Care Close to Home

10 Thank You to Our Donors

12 Research Briefs

CONTRIBUTORS

Jennifer Durgin Ann Klein Lauren Seidman Sharon Tregaskis

DESIGN PRODUCTION

Farah R. Doyle

PHOTOGRAPHY

Cover and photos on pp. 3, 4, 5, 6, 10, and back cover by Mark Washburn PRODUCED BY

Office ofDeveqopment andAqumni ReqaD ons

A MES SAG E FR O M K E I T H LO UD Our purpose at Children’s Hospital at Dartmouth-Hitchcock (CHaD) is to help all children lead their healthiest, happiest lives. As New Hampshire’s only children’s hospital we deliver the best care, in the right place, every time, and our discovery, education, and advocacy missions in partnership with the Geisel School of Medicine at Dartmouth extend well beyond state lines. I am incredibly proud of the shared and unwavering commitment our team has to our goals. At the same time, I am humbled by the generosity of our community, which helps us to deliver on this promise every day.

The past year-and-a-half has presented unanticipated new challenges for CHaD, as it has for all of you. Since the start of the COVID-19 pandemic, we have seen an increased need for the services provided through the Ken & Vickie French Child Advocacy and Protection Program (CAPP) and for mental and behavioral health services; encountered more families dealing with food insecurity; and discovered that the use of telehealth is not just increasingly convenient, but necessary, and critical at times. With growth in these areas of need as well as others, we have also seen an increase in support from families and friends in our CHaD community, which has allowed us to elevate our family-centered approach to care.

I am mindful that every dollar donated and every hour volunteered represents an investment in strengthening the care of our children and the experience of our families. It is this shared commitment not only to our patients but also to our communities that makes CHaD so special.

Moving forward together, no matter what the future brings, we can be confident that the health and happiness of all CHaD kids is in good hands.

Thank you for your trust and your support.

In gratitude,

Dartmouth-Hitchcock | Geisel School of Medicine at Dartmouth One Medical Center Drive, HB 7070 Lebanon, NH 03756

Keith J. Loud, MD, MSc CHaD Physician-in-Chief, Chair and Associate Professor of Pediatrics, Geisel School of Medicine

T E L E H E A LT H

A Lifeline

FOR NEWBORNS IN NEED

E

rika*, an obstetrics nurse for just over a year, received the call around 3:00 am: An ambulance was on its way to her rural Northern New England hospital with a woman in preterm labor. Up until that point it had been a typical night, with a bare-bones labor and delivery (L&D) staff of one other obstetrics nurse on the floor and a third nurse on-call. When the patient arrived on a stretcher, bearing

down and pushing, the hospital’s midwife, obstetrician, and pediatrician were all still en route. Erika examined the patient and saw the baby’s head.

“At that point I thought that there was going to be a baby born right into my hands,” Erika says.

“Which would have been my first delivery.”

Then the patient’s contractions stopped, and the baby’s head was no longer visible. Erika had a window of opportunity, and she used it to call into Dartmouth-Hitchcock’s (D-H) TeleIntensive Care Nursery (TeleICN).

1/2 1/2 of all U.S. counties do not have OB-GYN doctors to serve pregnant women

10 In NH, 10 hospitals have closed their Labor & Delivery units since 2000

60K 60,000 women of child-bearing age in Northern New England live farther than 15 miles from a maternity ward

*Names and some details about this case have been changed to protect patient privacy.

Cheshire Medical Center in Keene, N.H., was the first site to utilize D-H’s TeleICN services in 2018. Pictured here are pediatrician Deborah Hansen, MD, and Logan F., RN.

FILLING A GROWING NEED The Children’s Hospital at Dartmouth-Hitchcock (CHaD) is New Hampshire’s only comprehensive, full-service children’s hospital. In its intensive care nurseryPICNQ criDcaqqyiqq infants from throughout the region receive expert, high-quality care. But what happens when babies need urgent, expert care before they’re at DartmouthHitchcock Medical Center?

Since 2018, D-H has been offeringTeqeIserv NC icestocriDcaq access and community hospitals throughout Northern New England.

Using a secure app that ensures paDentprivacydboardJcerDfied

D-H neonatologists are able to join local bedside teams from their phones, tablets, or computers to provide around-the-clock, realme D assessmentandtreatment recommendaDonsthrough telemedicine. Today, nine sites in New Hampshire and Vermont are eitherqiz Du ingtheserviceorinthe processofimpqemenDngit:TeqeINC is one of eight telemedicine servicesofferedbyartmou D thJ Hitchcock Connected Care.

TeqeICN fiqqs a growing need in the region. In New Hampshire, where birth rates are declining, Medicaid reimbursement rates are low, and obstetricians are scarce, 10 hospitals have closed their L&D units since 2000. That means pregnant women are traveling

TeleICN fills a growing need in the region. In New Hampshire, where birth rates are declining, Medicaid reimbursement rates are low, and obstetricians are scarce, 10 hospitals have closed their Labor & Delivery units since 2000. farther from home for their care and, in some cases, giving birth in the closest emergency room. To address these challenges, TeleICN is available to L&D units and to emergency departments.

Michelle Tyler, MD, a neonatologist at CHaD and an assistant professor of pediatrics at the Geisel School of Medicine, says, “This service is so helpful to local providers who could use support and assistance with sick newborns. It takes a long D me to traveq pqaces in su ch a rural region and the TeleICN connecD on aqqow s u s to bett er manage paD ents u nD q ou r team can get to them.”

› DA RT MO U T H - H I TCH CO C K

3

Story continues on next page . . .

GE IS E L S C HO O L O F M E DIC INE

THE POWER OF TEAMWORK In Erika’s case, early contact with D-H TeleICN allowed her team to prepare for the birth of an extremely preterm infant. “We knew the D-H neonatologist would lead the resuscitaDonandtherespiratory therapist, pediatrician, and I would befiqqingariou v sroqesd?shesays: Theysetpu theoperaDngroom with micro-preemie equipment andposiDonedaniPadsothat the neonatologist would be able toisu v aqizetheinfantduring resuscitaDon:>Wereceivedgreat feedbackinreaqme: D avH inga provider more experienced with premature babies was reassuring for us, and helped us be more comfortabqeith w theresuscitaDon:?

SteveRingerddMD hDP dsecDon chief of neonatology and a professor of pediatrics at Geisel, says, “We embarked on TeleICN so we could provide the best possible support. And one of the things that makesthisbetterthanew ever imagined is that the neonatologist isinaposiDonofteamqeaderwhofs able to look at everything that’s going on. It allows everybody else to focus on taking care of the baby.”

The baby Erika helped deliver was stabiqized and transferred to CHaD’s ICN by the Dartmouth-Hitchcock Advanced Response Team (DHART) neonatal transport crew. DHART can be looped in to all TeleICN calls, so the team knows what to expect when it gets to a hospital, and local

providers know exactly when the helicopter or ambulance will arrive.

KEEPING CARE LOCAL One ofthe benefits ofTeqeICN is that it prevents unnecessary transfers. While extremely preterm newborns and othercriD caqqyiqq infants need the life-saving care provided at CHaD, some babies have condiD ons that can be moni tored and treated right where they are:Video capabiqiD es aqso aqqow neonatologists to help local providers rule out problems like neonatal encephalopathy—a syndrome in which neuroqogicaq funcD on is dis turbed—that would require treatment in the ICN.

“The most important piece for us is just figuring out how best we can help the providers on the ground with that baby. It’s our job to be flexible and to help in whatever capacity they need.”

Michelle Tyler, MD, CHaD neonatologist, trains local providers in the use of telehealth technology through practice calls.

CH I LD HE A LTH

4

FA LL 2 0 2 1

“Before telemedicine, when we provided consults by phone, newborns with suspected encephalopathy were sent to us automatically, which was traumatic for families,” Tyler explains. “It’s so much easier now that we can walk through a neurological exam together with a pediatrician and get a clear sense of what’s going on with a baby. We can reassure providers and families that these babies look perfect and don’t have to come to us.”

And that’s one of the primary goals of TeleICN and all the telemedicine services offered by D-H: To bring the expertise of an academic medical center to families throughout the region, regardless of where they are. CHaD neonatologists are committed to helping any sick infant anywhere—especially when their involvement means a baby gets to stay in its community and a family avoids the stress and expense of travel to D-H.

ACCESSIBILITY AND FLEXIBILITY To that end, D-H has made implementation of TeleICN easy for regional hospitals. Tyler says, “With some telemedicine services you have to outfit an entire room with cameras and other expensive equipment because there’s so much interaction needed. For us, instead of fancy, large equipment, the best solution is an iPad that can be placed right up to the baby.”

While regional providers like Erika hope they never have to use the TeleICN service, they’re grateful to have it. “We took full advantage of the CHaD neonatologist’s experience and will do so again in the future,” she says.

“The most important piece for us is just figuring out how best we can help the providers on the ground with that baby,” Tyler says. “Whether they want us to lead resuscitation, be a second set of eyes, talk with a family, or mobilize a transport team, it’s our job to be flexible and to help in whatever capacity they need.”

With your help, CHaD’s ICN can offer even more to the families in our region.

Please contact Polly Antol, Director of Development for Child Health Initiatives, at 603-646-5316 or Polly.Antol@Hitchcock.org for more information.

DA RT MO U T H - H I TCH CO C K

5

GE IS E L S C HO O L O F M E DIC INE

Charlie Eaton was five years old when the severe anxieties and terrifying hallucinations began. By seven, life was unbearable, and his mom was desperate for help. Then, a doctor in Boston confirmed that Charlie had a form of pediatric acute-onset neuropsychiatric syndrome (PANS) and referred them to a highly specialized team at the Children’s Hospital at Dartmouth-Hitchcock. Under their care, Charlie has finally gotten the help he needs. The hallucinations are gone, the anxieties are lessening, and Charlie is back to enjoying life, including going to the beach in their hometown of Seabrook, New Hampshire.

M E N T A L H E A LT H

Helping Children WITH PANS

nO e morning, oyur child waek s up and seems like a H W W H W W W H HyW H W H W as A P NS—pediatric acute-onset neuropsychiatric W y y H W L W LH H .

H

W W L H H

L

L L L L

W H

W W u L

H

W H W &H L W H W H y H H W LH W L W HL W W W L L H LH LL H H

H

H H H

W H

W

W

H

W

W y W HOPE TOWH W W H “ONEL DAY, WE W LH W y W H LEVERAGE THE POWER OF W LW W W

THE GUT MICROBIOME AND y LH W wW H y OTHER INTERVENTIONS yHy W H LLW TO TRULY HEAL THESE -H L CHILDREN, H L W AND, W H W W HELP THEM H ULTIMATELY, H H LH W W LIVE THEIR HAPPIEST, W H W L L y W W W H W L WHy W HEALTHIEST LIVES.” WL H W H —Juliette Madan, H LH H W wW W LH

W -W

CH I LD HE A LTH

6

FA LL 2 0 2 1

WH uH MD, MSH W WW

H

H L

H

H

Hope through PING In 2019, Madan teamed up with pediatric neurologist Richard Morse, MD, and colleagues in rheumatology and immunoqogytocreatethesyP chiatrymmuI noqogyeuN roq ogyrou G pPPQ GNI ithin w artmou D thJHitchcockandaDHC : Thecqinic GNIP heqpschiqdrenhose w psychiatricsymp tomsmaybereqatedtoinflammaDoninthebrainthatas w triggeredbyaninfecDondsuchasstreptococcaqpharyngiDsd mycoplasma pneumonia, or, more recently, COVID-19. ach E speciaqistcontributestheirexperDseandrecommen daDonstoheqpthesechiqdren: ften O achiqdfsorst w symptomsdisappearithin w days of receiving the right treatment. Within months, many children are symptom free and working with therapists to movepastanyqingeringanxieDes: “We must open our minds to the possibility that some children with severe behavioral and psychiatric syndromes have annderqy u ingimmunedinfecDousdorinflammatoryprocessd? explains Madan. “A very small percentage of children have suchcondiDonsdprobabqyqessthanwofaqqchiqdrendbut forthesepaDentsandtheirfamiqiesdtheimpactisenormous andrequiresamuqDJprongedapproach:?

Investigating the Gut-Brain Connection Finding the underlying cause of diseases in children has been Madan’s passion for more than a decade. An associate professor of pediatrics and epidemiology and facuqtymemberofthe quanD taDve biomedicaq sciences graduate program at the Geisel School of Medicine at Dartmouthd Madan is the qongDme cqinicaq directorof research for Geisel’s Children’s Environmental Health and Disease PrevenD on Research CenterP>Chiqdrenfs Center”), a top fundraising priority for the school. In that role, she helps direct the New Hampshire Birth Cohort Study, which collects health data and biological samples from over 2,000 pregnant women and their children at key developmental points in infancy and early childhood.

As part of the Children’s Center, Madan’s research team studies the early life microbiome: the ecosystem of microscopicorganismsthatinhabitourskinddigesDev tractdand many other organs. In the gut, the microbiome helps reguqatedigesDondtraintheimmunesystemdanddriveneuro deveqopmentdhich w thenaffectsemoDonsandbehaviors:

DA RT MO U T H - H I TCH CO C K

7

ThismakesitaprimeqocaDontostudyandpotenDaqqy heal behavioral, neurological, and immune disorders— incqudingSd NA P ausmd D anxietydandinattenDon: Theausm D communityhasqongembracedthegutJbrain connecDonandthepossibiqitythatdysreguqatedimmune systemscontributetoausDD cbehaviors:onsider C that chiqdrenith w ausm D havehighratesofaqqergiesdasthmad anxietyddDH A anddigesDev disorders: >Thepatternsthatew idenDfyinthemicrobiomeand that relate to disease can be altered,” explains Madan, >givingustremendoushopeforprevenDonandtreaDng disease.” A recent study from Madan’s lab has shown thatchiqdrenwhoexhibitauDsmJreqatedbehaviorsby agehaveunusuaqpopuqaDonsofmicroorganismsinthe gut. More research and funding is needed to determine targets for treatment.

Gifts to Power Research and Care In the nextyeard Madan hopes to attract phiqanthropic and grant funding to support several clinical studies aimed at deveqoping intervenD onsffisuch as fecaq trans pqants and probioD csffithat couqd heqp chiqdrenwith ANPSd auD smd orotherreqated iqqnesses:

-

RecentqydtheouF EC A P ndaDonhasfaciqitatedfundingin supportofSNA P careatartmou D thJHitchcockandits parDcipaDoninanaDonaqnetworkofacademicmedicaq centers that collaborate to study and treat pediatric autoimmuneneuroqogicaqdisorders:is EC A P aqsoarranging fundingforamicrobiomestudyofchiqdrenith w Sd NA P with the chief collaborators being researchers at Geisel’s hiqdrenfs C enter C andtheUniversityofriz A ona: “One day, we hope to leverage the power of the gut microbiome and otherintervenD ons to truqyheaq these chiqdrend andd uqD mateqyd heqp them qive theirhappiestd healthiest lives,” Madan says.

PFamiqieswho think theirchiqd maybenefit from a PING consuqt shouqd taqk firstwith theirprimarycare doctor and/or mental health provider, if they have one.)

To support children’s health research, contact Polly Antol, Director of Development for Child Health Initiatives, at 603-646-5316 or Polly.Antol@Hitchcock.org.

GE IS E L S C HO O L O F M E DIC INE

FIVE WAYS that CHaD Cares for the Whole Child

When a child is sick or injured, they need more than just medical treatment. They need care that attends to their social, emotional, and mental wellbeing—care that helps them and their families thrive.

BOYLE COMMUNITY PEDIATRICS PROGRAM: Pediatric residents learn how to advocate for children and their families and work with local organizations. They also spend time with families outside of the clinic to gain a deeper understanding of daily life for children with chronic illnesses.

2

CHILD LIFE PROGRAM: Using therapeutic play and activities, child life specialists help children and adolescents cope with the stresses, fears, and other strong emotions that accompany illness and medical procedures.

1

KEN & VICKIE FRENCH CHILD ADVOCACY AND PROTECTION PROGRAM (CAPP): A specialized clinical team works closely with social services, police, and legal professionals to provide a safe and healing environment for children and families when there are concerns about child abuse and neglect. Importantly, this team works to prevent child maltreatment in our communities.

3

MOMS IN RECOVERY: Caring well for children means caring well for their moms, too. This pioneering program provides highly coordinated, nurturing primary care, mental health care, and social supports for moms who are recovering from substance misuse, and for their children.

4

WHOLE CHILD CARE

MOLLY’S PLACE: A playroom, a resource library, snacks, strollers, computer access, and a caring staff member ready to assist—all this comes together in Molly’s Place, offering a respite for children and their families visiting Dartmouth-Hitchcock Medical Center.

5

SERVING THE REGION

W rldClass Care CLOSE TO HOME

For children with severe asthma, auD smd cancerd oranynumber of serious illnesses, frequent appointments and procedures are part of life. In southern New Hampshire—home to almost 300,000 children under the age of 18—accessing specialty pediatric care often means traveling an hour or more. More Dme in the carmeans qessDme for learning, playing, and simply being a kid. For parents and caregivers, long trips mean more stress, more expenses, and more Dme awayfromwork and home:

surgicaq condiD ons ofthe earsd nose, and throat, and other minor operaDons: Medicaq office space has expanded too, and now children who need an endoscopy or infusion therapy for a chronic illness can receive that care on site:These are just first steps: In the next two years, CHaD in Manchester is going to be transformed into a pediatric ambulatorydesD naD on center:

Families arriving at CHaD will come in through their own childfriendly entrance. Once inside, theyfqq find disD nctwaiD ng areas In order to meet the needs of for younger kids and for teens, a these families, CHaD in Manches- calming space for children with ter is growing. With the opening sensory processing disorders, and of a new Ambulatory Surgery separate areas for kids who are Center at Dartmouth-Hitchcock sick and kids coming in for their Manchester in the spring of weqqvisit:ediatric P primarycare 2021, kids and their families no providers and a growing cadre longer have to travel to CHaD of specialists will be located in in Lebanon for hernia repair, the same wing, making it easier

DA RT MO U T H - H I TCH CO C K

9

for families to navigate mulD pqe sameJdayappointments and strengthening coordinaD on between providers. And before, afterd orin between appoint mentsd chiqdren ofaqq abiqiD es can forget they’re even at a hospital while enjoying the brand new, fully accessible playground.

Families want to keep their care local. As CHaD grows, that’s exactly what more families will be able to do.

If you’d like to support the growth of CHaD in Manchester and help kids get the care they need closer to home, please contact Polly Antol, Director of Development for Child Health Initiatives, at 603-646-5316 or Polly.Antol@Hitchcock.org.

GE IS E L S C HO O L O F M E DIC INE

T H A N K YO U

THANK YOU TO OUR DONORS

Philanthropy plays a critical role in sustaining and advancing children’s health research at the Geisel School of Medicine and the many important programs at the Children’s Hospital at Dartmouth-Hitchcock (CHaD). Caring for children costs more than caring for adults, yet reimbursements are much lower. However, no child or family is ever turned away from CHaD because of their inability to pay, no matter how complex or costly their care.

Philanthropy makes that possible and is vital to sustaining CHaD’s operations. These four stories highlight a few examples of your generosity. We are deeply grateful for each and every gift to CHaD, and thank you for your support, your caring, and your compassion.

CH I LD HE A LTH

10

FA LL 2 0 2 1

EMPOWERING PATIENTS, FAMILIES, AND THEIR COMMUNITIES

PROTECTING OUR CHILDREN

A quarter of a century: that’s how long Jane Stetson hasbeensupporDngtheoyB qeommu C nityediat P ricsrogram: P qong A ith w qongDmeaDHC pediatrician William Boyle, MD, Jane cofounded the program in :TheacDiDv esoftheoyB qerogram P arenited u by a common vision to empower families of children who aredeaqingith w chroniccondiDonsdbothithin w the health care system and out in the community.

TheoyB qerogram P carriesoutitsmissionthrough aariety v ofeducaDonaqdcqinicaqdandadvocacy iniDaDes: v or F exampqeditsamiqy F dvA isoryoard B andarents P inRecoverygroupsheqpaDCH carefor chiqdrenandtheirfamiqiesffibygeDfingfluorideon the teeth of underserved children, food boxes to families facing food insecurity, or Recovery Friendly Cqinicsforfamiqiesaffectedbytheopioidepidemic: nd A sinceitsincepDondtheoyB qerogram P has beencommittedtotrainingmedicaqstudentsand residentstopracDcefamiqyJcenteredcareandqook beyondthediseasetheyere w treaDng: uFnded enDreqythrough phiqanthropyd the Boyqe Pro gram has heqped transform care bypuDfing famiqies at the center and tackling some of the toughest issues faced bycommuniDes:Todayd thanks to Jane and Bill Stetson’s ongoing generosity and involvement, and gifts from otherdonorsd the Boyqe Program conDnues to train the next generaDon ofpediatricians inwork ing with families, schools, and community to make change that reaqqymatters to kids:

HELP FOR CHILDREN IN DISTRESS Jonathan Guloyan knew the anguish of needing support and not being able to get it, and he was determinedtomakeadifferenceintheqivesofchiqdren withmentaqheaqthneeds:Whenhedieddheqeftj: miqqionthatfsbeingusedtofundcoqqaboraDev behav ioral health—a team-based approach to treatment that integrates mental health care with pediatric primary caredenabqingmorechiqdrentogettheattenDonthey need, when they need it. Mirroring Dartmouth-HitchcockfsPDJHQsuccessfuqintegraDonofbehavioraq heaqthintoaduqtprimarycaredcoqqaboraDev behavioraq heaqthataDCH increasespaDentaccesstomentaq heaqthtreatmentthroughthepediatricpracDcesfam ilies know and trust. More funding is urgently needed to meet the increasing demand for this service.

WHOLESALE GENEROSITY Since 1998, C&S Wholesale Grocers—the largest wholesale grocery supply company in the U.S.—has been helping children facing childhood cancer and hunger receive the care and support they need. The hS C hariD C esTeeUpforids K annuaqgoqftournament hasprovidedcqosetojmiqqioninsupportofaDHC fs pediatric oncology program to help ensure that CHaD kids facing cancer not only have access to the latest therapies and clinical trials but also the comprehensive support that they and their families need.

NO CHILD OR FAMILY IS EVER TURNED AWAY BECAUSE OF THEIR INABILITY TO PAY, NO MATTER HOW COMPLEX OR COSTLY THEIR CARE. DA RT MO U T H - H I TCH CO C K

The Ken and Vickie French Child Advocacy and ProtecD on Program PCAP Q takes care ofourmost vuqnerabqe popuqaD onffichiqdrenwho maybevicD ms ofabuse ornegqect: CAP provides cruciaq services and individuaqized treatment to hundreds ofchiqdren a year, while health insurers cover this care at a rate of only about 10 percent. Nancy Morrell, her son Justin McLaned andJusD nfswifed Angeline McLane, are dedicated supporters ofCAP fsvitaqd compas sionatework: In addiD on to a pqanned giftd Morreqq makes annuaq donaD ons to CAPfficontribuD ons that are matched by the McLanes.

11

GE IS E L S C HO O L O F M E DIC INE

RESEARCH BRIEFS

A

child’s diagnosis with Fanconi Anemia launches their family on a journey into the unknown. The inherited genetic instability can trigger fatal complications including bone marrow failure, leukemia, and tumors. Subsequent treatments, while lifesaving, can themselves negatively affect a child’s development and lifespan.

Doing Better for Kids with Fanconi Anemia

Bonnie Lau, MD, PhD, designs her research to answer the questions she hears from patients and their families at the Children’s Hospital at Dartmouth-Hitchcock (CHaD).

Consider prognosis. Only a subset of children with Fanconi Anemia develop bone marrow failure, a precursor to leukemia, but clinicians have no way to predict who is at risk. “Leukemia is the most common cancer we see,” says Lau, “and it’s what parents fear the most.” Lau analyzed bone marrow samples provided by patients and found the types of genetic mutations that distinguished children with Fanconi Anemia who developed bone marrow failure from those who did not. Her analyses could help clinicians forecast disease severity and trajectory.

L

otions, room fresheners, cleaning sprays—if they’re sold at your favorite store, they must be safe, right?

Chemical Exposures During Pregnancy C HI L D H EALT H

12

FA LL 2 0 2 1

Wrong, say Margaret Karagas, PhD, and Megan Romano, PhD, who note that while the Food and Drug Agency requires clinical trials for new drug approval, it has little authority to regulate personal care products.

“There are so many chemicals on the market that are commonly consumed

Such analyses also inform Lau’s efforts to replicate the biology of Fanconi Anemia cancers in her laboratory and find better treatments. She sees particular promise in immunotherapy, which boosts a patient’s own immune response to cancer. Lau used the gene-editing tool CRISPR to modify human cells in which she is now testing whether certain immunotherapeutics that are FDA approved for adult cancers can stop Fanconi Anemia-related cancers in children.

She also engineered a mouse model with the mutations that cause cancer in Fanconi Anemia patients, as well as human immune cells.

Clinicians treating Fanconi Anemia patients with cancer will be able to use Lau’s model to find the best treatments for a particular child.

“Patients go through the ringer with side effects because of treatment,” says Lau, “and I felt we needed to do better.”

Bonnie Lau, MD, PhD, is a pediatric hematologist-oncologist at CHaD and at Dartmouth and Dartmouth-Hitchcock’s Norris Cotton Cancer Center. She’s also an assistant professor of pediatrics and of molecular cell biology at the Geisel School of Medicine.

and very rarely tested for safety in humans,” Karagas says.

It’s one of the reasons they launched a study to assess chemicals women are exposed to during pregnancy, often unwittingly through products they use to care for their bodies and clean their homes. In the study, which was published in Frontiers in Public Health, 255 rural New England women wore silicone wristbands that captured chemicals in

A

Do You Want Fries with that Toy?

their environments, providing a window into exposure that could impact the lives of their unborn children.

Romano, the study’s senior author, noted that many of the chemicals detected by the wristbands were components of synthetic fragrances found in personal care and household products that contain phthalates, chemicals used to keep the scents from dissipating. That’s a concern, because phthalate exposure

Dartmouth-led study published in the journal Pediatrics found that the disproportionate use of premiums within child-targeted TV advertising for children’s fast-food meals is deceptive. The researchers report that these ads often overemphasize premiums such as toy giveaways and games relative to the fast food itself. This marketing practice violates the industry’s own guidelines—put in place to ensure that the use of premiums in ads is not deceptive or unfair—as young children lack the cognitive ability to understand advertising.

“In the past, we’ve looked at the prevalence of child-directed food marketing and how it negatively impacts kids’ diets, behaviors, and even weight status, but this is the first time we’ve examined if these companies are adhering to their own guidelines, in relationship to the content they can present to children,” explains first author Jennifer Emond, PhD, MS. The investigators analyzed content of all child-directed fast-food TV advertisements on four popular national networks from February 1, 2019,

has been linked to life-threatening complications for pregnant women and their babies. Studies have also associated prenatal phthalate exposure with asthma, sexual organ deformity, and fertility problems as well as ADHD, lowered IQ, autism, and psychomotor development.

Karagas and Romano describe research like theirs as underfunded but vital in a nation where food, water, and products are often considered

DA RTM O U TH-HITC HC O C K

through January 31, 2020—more than 20,000 ads from 11 fast food restaurant chains. They quantified the percent of the audio transcript (word count) and visual airtime (seconds) that included premiums or food, as well as the onscreen size of the toys or giveaways.

Advertising for McDonald’s Happy Meal accounted for nearly all (99.8 percent) of the total airtime during the study year. On average, premiums (vs. food) accounted for a majority of words in the audio transcript and of the visual airtime. Industry guidelines clearly state that premiums within child-directed advertising must be secondary to the advertised product to avoid undue influence.

“These are self-regulatory guidelines or pledges that the companies have signed on to as part of an industry initiative,” says Emond. “But they’re not even adhering to their own pledges.

We need to hold them accountable.”

Watch a video about this research at dartgo.org/child-targeted-tv-ads Jennifer Emond, PhD, is an assistant professor of biomedical data science and of pediatrics at Geisel.

innocent until proven guilty. “It helps to motivate people to push for policy change if they don’t like the way things are,” Romano said, “and it empowers them to make decisions about their day-to-day environment to help keep themselves and their families safe.”

Margaret Karagas, PhD, is department chair and James W. Squires Professor of Epidemiology at Geisel and director of the Children’s Environmental Health and Disease Prevention Research Center, a top fundraising priority for Geisel.

Megan Romano, PhD, is an assistant professor of epidemiology at Geisel.

13

GE IS E L S C HO O L OF MED ICINE

Non-Profit Org. U.S. Postage PAID Permit No. 211 Wht Riv Jct, VT

Office of Development & Alumni Relations One Medical Center Drive (HB 7070) Lebanon, NH 03756-0001

H E A LT H L E A D E R S C I R C L E

Support the Health and Wellness of Our Region’s Children Through Leadership Annual Giving

Annual fund support is the foundaDonofexceqqenceforouracademic medicaqcenterdsupporDngcriDcaq areas of need. Over the past year, more than 120 individuals have joined our Health Leaders Circle by makingunrestrictedgiftsofjd or more to the Children’s Hospital at Dartmouth-Hitchcock (CHaD), Dartmouth and Dartmouth-Hitchcockfsorris N ottC onCancerenterd C the Geisel School of Medicine, or Dartmouth-Hitchcock.

Many of the programs and services that make CHaD so special are only possible through philanthropic support:Thesegiftsaqqowsu toserve all children regardless of a family’s ability to pay for medical expenses.

UnrestrictedgiftstoaDHC havean immediate impact on the youngest members of our community.

Joining the Health Leaders Circle is one way to demonstrate your commitment to our children’s hospital

and to the families of our region, andtodirectqybenefittheqivesof ourpaDentsandtheork w ofour researchers, physicians, and trainees.

To learn more about the Health Leaders Circle and opportunities to support CHaD’s greatest needs, please contact Polly Antol at 603-646-5316 or polly.antol@hitchcock.org.

go.d-h.org/donate/HealthLeadersCircle