Fresh Start - The Monroe Carell Jr. Children`s Hospital at Vanderbilt

Transcription

CHILDRENSHOSPITAL.VANDERBILT.ORG
SUMMER 2013
Fresh
Start
Teaching families to
lead healthy, active lives
The Great Defender
Helping children who need brain surgery
Raising Miracles
Celebrating 30 years of Children’s
Miracle Network Hospitals
contents
02
SUMMER 2013
08
cover story
departments
02 Fresh Start
01 Thoughts on Hope
For the past five years, Monroe Carell
Jr. Children’s Hospital at Vanderbilt
has partnered with Nashville’s leaders
to reduce childhood obesity in the
community by helping families be
active and eat well.
features
08 The Great Defender
For patients who need brain surgery,
John “Jay” Wellons III, M.D., the new
chief of Pediatric Neurosurgery, truly is
a superhero.
14 Infectious Teamwork
With the highest level of intensive care,
a deep bench of specialists and collaboration, the infectious disease team at
Monroe Carell Jr. Children’s Hospital at
Vanderbilt is busy tackling age-old
mysteries to prevent and treat illnesses.
20 Raising Miracles
Exploring better ways of giving
children and families hope for a
healthier tomorrow.
26 Pioneers of Hope
Meet four physicians working to
discover better treatments and cures
for children.
30 Giving Hope
People and events making a
difference in children’s lives
20
32 Discovering Hope
The latest in Children’s Hospital
research
CONNECT
Scan this Quick Response code (QR) with your smartphone to link directly to Hope online.
Or simply visit childrenshospital.vanderbilt.org to find ways to connect
to other families, patients and research news.
In 1983, the Children’s Miracle Network
Hospitals was born when 20 hospitals
from across the nation banded together
to raise funds and awareness for children’s hospitals, including Vanderbilt.
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97,246 fans on facebook.
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@VUMCchildren
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THO UGHT S O N
E
VERY DAY, WE STRIVE TO IMPROVE THE HEALTH
and well-being of children
through our state-of-the-art clinical care, our commitment to discovery of
better ways to treat disease, and our passion for educating the next generation
of pediatric providers. We do most of this great work right here at Monroe Carell Jr.
Children’s Hospital at Vanderbilt, like our neurosurgical program where we have
physicians bringing together their expertise, technological advances and research to
achieve improved outcomes for complex conditions of the brain. But some of our
work, particularly work aimed at prevention and teaching about health, goes outside
the footprint of our hospital and clinics.
We are learning that oftentimes, the antecedents of adult disease begin during
childhood. We also know that we have shifting trends in some diseases, like type 2
diabetes, once considered only an adult onset disease but now seen increasingly in
older children and adolescents. As we look for better ways to encourage prevention
and teach about risks of disease, we turn to our community partners—a theme that
we believe is important to all that we do every day.
For over five decades, the Division of Pediatric Infectious Disease has partnered
with community pediatricians to conduct studies about vaccines designed to reduce
and in some cases virtually eliminate childhood diseases. Because of their work, we
not only have better vaccines but a greater understanding of the role vaccines play in
overall health of our population.
Since the opening of our hospital nearly 10 years ago, we have had a focus on
promotion of healthy lifestyles for children. This began as advocacy for safety and
health education but in recent years has expanded to studying the triggers of
childhood obesity and developing partnerships with our community programs to
promote not only safety and activity but also teaching about healthy eating—
teaching about growing food and cooking that food in healthy ways. Our team wants
children to GROW well, even as we learn more about how to help them do just that.
Every day we see miracles—and every day our teams go out into the world
hoping to make a difference in the lives of children and their families. Our work could
not happen without our supporters. Over the past year, we have celebrated long
relationships with the Junior League of Nashville, Friends of Children’s Hospital and
now Children’s Miracle Network Hospitals. As one of the founding hospitals in CMN,
we are grateful for how their support lets us explore new and better ways of giving
children and families hope for a healthier tomorrow.
Sincerely,
Luke Gregory, FACHE
Chief executive officer
Chief executive officer, Monroe Carell Jr. Children’s
Hospital at Vanderbilt
Luke GreGory, FACHe
Chief of staff and executive medical director,
Monroe Carell Jr. Children’s Hospital at Vanderbilt
MeG rusH, M.D.
Pediatrician-in-chief, chair of the Department of
Pediatrics and James C. Overall Professor
steven Webber, MbCHb, MrCP
Surgeon-in-chief, director of the Division of Pediatric
Urology and Monroe Carell Jr. Chair
JoHn W. broCk III, M.D.
Assistant Vice Chancellor for Development
CInDy seAy
Editor
CHrIstInA eCHeGArAy
Contributors
CAroLe bArtoo, LesLIe HILL, PAuLA
Jones, JessICA PAsLey, WAyne WooD
Director of Publications
nAnCy HuMPHrey
Photography
DAnIeL DuboIs, LAuren HoLLAnD, Joe
HoWeLL, toMMy LAWson, Anne rAyner,
JoHn russeLL, susAn urMy
Design and Art Direction
DIAnA Duren
Executive Director of New Media and
Electronic Publications
WAyne WooD
Editorial Office
vAnDerbILt unIversIty MeDICAL Center
oFFICe oF neWs AnD CoMMunICAtIons
1161 21st Avenue soutH
t-5200 MeDICAL Center nortH
nAsHvILLe, tn 37232-2390
(615) 322-4747
Meg Rush, M.D.
Chief of staff and executive medical director
John W. Brock III, M.D.
Surgeon-in-chief, director of the Division of Pediatric Urology and Monroe Carell Jr. Chair
Steven Webber, MBChB, MRCP
Pediatrician-in-chief, Chair of the Department of Pediatrics and James C. Overall Professor
This paper is certified by the Forest Stewardship
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viable management of the world’s forests.
C H I L D R E N S H O S P I TA L . V A N D E R B I LT. O R G
01
Yesenia Mota and daughter, Ariana
Nataly, 5, are participants in a collaborative effort between Vanderbilt
and Metro Nashville to help families
lead more active, healthy lives.
02
FA L L / W I N T E R 2 0 1 2
Fresh Start
This late afternoon the Coleman Park Community
Center is brimming with children and the laughter,
shouts and pounding feet that they bring.
The dribble of a basketball and the squeak of tennis shoes compete with
the back-and-forth of a ping-pong game and the echo of water splashing
from the pool down the hall.
Yesenia Mota’s two children, Ariana Nataly, 5, and Manuel de Jesus, 4, participate in the center’s activities as part of a program called the GROW
trial, to learn how to be more active and eat better. They also take part in
a class that gathers in one of the center’s community rooms, where a
partnership between Monroe Carell Jr. Children’s Hospital at Vanderbilt
and Metro Nashville Parks and Recreation is hoping to reduce childhood
obesity by influencing families to live healthier lives.
written by Wayne Wood
photograph by Daniel Dubois
03
“I come from a family
where we eat a lot of fat,”
Mota says, speaking in Spanish through an interpreter at the
Coleman Center, located near the intersection of Nashville’s
ompson Lane and Nolensville Road. She notes that in her
home country of Mexico, foods such as meat, soft drinks and
snack foods are looked upon as status symbols, signs that a
person is doing well financially and can afford such foods.
“I’m really happy for the program, for teaching my children to eat more healthily. Now they know they don’t have to
eat chips,” she says with a smile.
For the past five years, the Children’s Hospital has partnered with the Parks and Recreation Department in a community-based effort against obesity, the Nashville Collaborative.
Such an effort is especially needed in Tennessee. According
to the 2007 National Survey of Children’s Health, 36.5 percent
of children in Tennessee are either overweight or obese, and
the state now has the eighth highest rate of childhood obesity
in the United States. Almost one in four preschool-age children
is already overweight or obese. As these children grow into
adulthood, this makes them more likely to suffer from diabetes,
heart disease and a host of other ailments.
Based on the data and obesity trends, experts have noted
that for the first time in generations, children born in the year
2000 will have a shorter lifespan than their parents.
The GROW trial is funded by a $12 million, seven-year
grant awarded in 2010 by the National Institutes of Health
(NIH). The formal name of the program is “Growing Right
Onto Wellness: Changing Early Body Mass Index (BMI)
Trajectories,” and the study’s primary investigator is Shari
Barkin, M.D., William K. Warren Foundation Professor of
Medicine, director of Pediatric Obesity Research at the
Diabetes Research and Training Center at Vanderbilt and
director of the Division of General Pediatrics.
“My purpose in life is to measurably improve child health
outcomes,” she says. “If you can change something as complex
as childhood obesity, even in small ways, you can change their
health for a lifetime.”
Barkin’s office, located in the Doctors’ Office Tower at
Children’s Hospital, is just steps away from one of the pediatric clinics that children and their parents pour through daily
and the staff of pediatricians treats everything from minor
illnesses to major diseases.
As the director of the Division of General Pediatrics,
Barkin has thousands of children in her care and in the care of
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SUMMER 2013
the physicians she oversees, and says she has been troubled
throughout her career by the health challenges faced by children struggling with obesity.
As laudable as helping children, one at a time, is, Barkin
says that the GROW trial seeks to address underlying systemic
issues to influence the health of populations. The Collaborative
and the GROW trial are ambitious, maybe even audacious,
attempts to find a way to systematically affect one of the most
stubborn public health problems in the country.
“Anytime you build something, you want it to make a difference in a way that is measurable, meaningful and sustainable,”
she says. “We’re developing new ideas and testing them. Then
it’s about spreading them and making them available.”
The effort has the full attention and support of Nashville’s
Mayor Karl Dean, who also has created several healthy eating,
active living programs in the metropolitan area.
“Teaching children and families about healthy eating and
active living is important as our city works toward improving
the well-being of all its citizens,” Dean said. “We are expanding
our greenways, building community centers and enhancing
other services of Metro Parks to make it easier for residents to
be active. I am proud that Metro Parks and an outstanding research institution like Vanderbilt University are partnering in
this important study.”
Making Changes
Participants in the GROW trial are registered in parentpreschooler pairs, or dyads, and come to one of two Metro
Parks and Recreation Community Centers to attend educational sessions, including cooking classes and parent-preschool
child exercise activities. These classes closely follow a defined
curriculum for research purposes, and are designed to give
participants the tools they need to make changes for both
young children and their parents—although, of course, the
effects spill over to the entire family.
The GROW trial, which is explicitly designed to prevent
childhood obesity, seeks to have 600 participants who stay
in the program for three years, during which, in various program phases, they will have classes in nutrition, physical
activity, good sleep patterns, controlled use of media, and use
of their environment to support a healthy lifestyle. There are
two options for the courses of learning: “healthy growth” or
“healthy childhood development for school success,” which
DaNIEl DUboIS
DaNIEl DUboIS
DaNIEl DUboIS
Rosa Maria Osario, with
have different points of emphasis
her three sons, twins David
to help researchers learn what
and Jonathan Alvarez, 6,
approaches are most helpful to
and Brian Alvarez, 7, have
changed the way they eat
participants.
thanks to GROW trial nutriAll of the children are at-risk
tion classes. They now shop
for obesity, but not yet obese, since for fruits and vegetables
instead of chips and soda.
GROW is a prevention trial.
The participating families get
a membership to the community center for the period of the
study, both while they are in classes and afterward, and they
can do a range of sports and activities. The community centers are basically sports buffets, offering basketball, swimming, ping pong, a walking track and more.
Classes at the Coleman Park Community Center are
conducted in Spanish, in recognition of the large Spanishspeaking population of the surrounding neighborhood.
Classes in English are taught at the East Park Community
Center on Woodland Street in East Nashville.
Talk to the participants in the trial, which on a recent
night was meeting for its sixth session out of 12 in the study’s
first phase, and it’s easy to begin to believe Barkin’s assertion
that a solution is possible.
Many things are different in Rosa Maria Osorio’s life since
she began participating in the GROW trial a few months ago.
“This program has completely changed my life,” she says
through interpreter Anne Crook, research field collector for
the GROW trial. Osorio was concerned about the health of her
older son, 7-year-old Brian Alvarez, and four months earlier
had talked to his Vanderbilt pediatrician, Adriana Bialostosky,
M.D., about what she could do.
“My son was depressed, he didn’t want to play, he wanted to
watch TV all the time,” she says. “Now it’s different—he wants to
be [at the community center] every day. He is always wanting to
get vegetables, fruit, water. Before, it was chips and hot dogs.”
She says her son Brian has dropped from size 12 pants to
size 8 in the few months she has been in the GROW trial. And,
tellingly, Brian is not even the child she is matched with for
purposes of the program; the other half of her dyad is her
younger son, David, 6, who was a preschooler when Osario
entered the program.
“I have suffered discrimination because of my size. Now
that I know what’s healthy to eat, I don’t want my children
to suffer the same thing,” she says. “[Session leader] Juan
[Escarfuller] is an incredible teacher—he motivates me.”
Escarfuller is an interventionist for the GROW Program.
Sitting beside Osario in the class is Yesenia Mota. Like
her classmate Osario, Mota is grateful for the information that
is helping her family have a healthier lifestyle.
Mota says that her family especially enjoys fruit and
yogurt, and have fun making fruit kabobs—an idea she picked
up at one of the classes.
05
“I’ve never made anything fun [to eat],” she says, with a
clear sense of pleasure at having learned something useful
and new.
A few miles away at the East Park Community Center, another class of GROW participants meets for the program. One
of the participants who recently finished the 12-week phase
of the program, and who asked only to be identified as Angela,
has five children, ages 13, 9, 7, 3 and 2. For purposes of the
trial, Angela is matched with her 3-year-old daughter, but she
is quick to say that what she is learning in the program benefits
her whole family.
“[We’re] just being aware of what we eat and trying to
change what we eat,” she says. “And being more active as a
family. [The program] motivated me to try to lose weight and
get more healthy.
“I get up and walk now—I wasn’t doing any of that.”
Angela says she is much more aware of reading labels on
food, and that she now makes a list before going to the store
to stay on track with her shopping.
“I know I wasn’t eating like I should. The GROW program
made me want to make changes,” she says.
Seeds for success
laUrEN HollaND
So far, there have been a dozen journal articles based on
work of the Collaborative, including in Pediatrics and the Journal
of Obesity, and Barkin has presented at the International Child
Health Conference and at the National Parks and Recreation annual meeting in Salt Lake City.
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SUMMER 2013
Among the early findings in the published research: First, a
culturally tailored and family-centered 12-week program can
change early growth patterns back to normal among Latino
preschoolers, especially those who are obese; second, two-thirds
of Latino families who attended culturally tailored programs
continued to use their neighborhood recreation centers for at
least the following year after the program ended, boding well for
sustainability of health changes; and third, these programs build
new social networks that tend to form among mothers who perceived their children to be of similar body types.
The GROW trial has also won two awards: In 2011, researchers presented at the Global Congress for Consensus in
Pediatrics and Child Health in Paris, France, and won the award
for best scientific abstract. That same year, the program won a
Special Achievement Award from the Tennessee Chapter of the
American Academy of Pediatrics.
It is the connection with Metropolitan Nashville Parks
and Recreation that provides one of the most unusual features
of the Collaborative and its GROW program, and, Barkin says,
one of its great strengths. “By using an existing infrastructure
intended to support health, once programs are tested and
found to be effective, they can easily be exported.”
Paul Widman, assistant director of the Recreation,
Cultural and Wellness Division of Metro Parks, says his department is an enthusiastic partner with the Collaborative
and the GROW program.
“The Collaborative is a great partnership for Metro Parks,”
he says. He notes that one of the key elements is bringing people into the facilities who might not otherwise be aware of all
that community centers and parks have to offer, even though
they have geographic access.
“I thought the program was very ambitious, but we know
there’s a need in the community,” he says. Speaking of the
work of the Collaborative that preceded the GROW trial, he
draws a line from the beginning of the Collaborative five years
ago and the success the GROW trial is having now.
“The strength of this is that we evaluate one project and
we work on the next one,” he says. “A lot of energy has come
out of each one, and we put it back to work.”
If the vision of the GROW trial comes true, a workable,
scalable prototype could be spread nationally through Parks
and Recreation departments. The seeds for that success are
already being planted.
Widman says that his colleagues in other Parks and Recreation departments around the country have taken notice of
the success that Vanderbilt and Metro Parks have achieved.
“There’s not many weeks
Shari Barkin, M.D., director
of Pediatric Obesity Research
that go by that I don’t hear from
at the Diabetes Research and
someone [from another city],” he
Training Center at Vanderbilt,
says.
“Most of the questions I get
is the primary investigator
for the GROW trial.
are about the partnership itself.”
“Part of what we’re testing is how
to use existing infrastructure to benefit health,” Barkin says. “National
parks and recreation centers reach
more than 230 million Americans,
and have the potential to utilize existing resources to support health.”
“Meaningful, sustainable and important” are three of the signposts of
the program from Barkin’s point of
view. Anyone talking to her for a few
minutes about her work senses a
Nashville Mayor Karl
burning intensity to help families live
Dean has made healthy
better lives.
eating, active living proEven earlier in her career, during
grams a part of his
legacy.
a fellowship at UCLA and a previous
faculty position at Wake Forest,
Barkin has worked to influence health in the communities in
which her young patients live.
“There are a lot of wonderful ideas, but they’re difficult to
test,” she says. “Your lab has to be the real world. These are big
public health problems and you can’t think about them one at
a time.”
And it takes a lot of planning and a lot of people to work on
a project with this many moving parts, too. There are research
coordinators, dietitians, bilingual research assistants and data
collectors, session leaders, and students, among others, who are
involved in making the program a reality.
Barkin says she is proud of the influence working with
the Nashville Collaborative has had on medical students. Some
have chosen careers involving community-based pediatric
research as a result.
“It affected the way they understood health, and for some
of them, it affected their career path,” she says.
She can’t help but smile when she talks about the end
result of the effort that she and those working with her on
the GROW trial are achieving: “There are families engaged in
healthy activity—not because somebody told them to, but because they want to.”
About the Nashville
Collaborative and the
GROW trial
The Nashville Collaborative, a
partnership between Monroe
Carell Jr. Children’s Hospital at
Vanderbilt and Metro Nashville
Parks and recreation to improve
child health, began in 2008.
The GroW trial, the largest of
the Collaborative’s projects, is an
effort to reduce childhood obesity
through a rigorously designed intervention that brings parentpreschool child pairs together to
learn either about healthy growth
or healthy development focused
on school readiness and success.
It had a two-year start-up and
pilot phase, and is now active in a
large, randomized and controlled
five-year trial at two Metro community centers—East Park and
Coleman Park.
both latino and africanamerican children are about
twice as likely to be obese by age
5 as are Caucasian children. The
GroW study has been designed
for minority preschoolers because
evidence shows weight trajectories are set early in life; so early
prevention is critical. If a child is
overweight or obese by age 8,
they are five times more likely to
stay that way as an adolescent.
Eligible families will be randomly assigned to participate
in either a healthy growth or
healthy childhood development
for school success course of
learning. both groups will build
sustainable health habits at
critical periods of childhood
development over a three-year
period.
Eligible participant pairs must
meet the following criteria:
• a Spanish- or English-speaking parent with one 3-to-5-yearold child who can participate
over a three-year period;
• The family should live or
participate in weekly activities
within a five-mile radius of either
East Park Community Center
or Coleman Park Community
Center;
• The child should have a body
mass index (bMI) that is greater
than the 50th percentile but less
than 95th percentile among
peers in their age group.
LeArn
More
For more information on registering for the GROW trial,
please call (615) 343-6441.
The project described was supported by Award Number U01HL103620-03 from
the National Heart, Lung, And Blood Institute, the Eunice Kennedy Shriver National
Institute of Child Health and Development and the Office of Behavioral and Social
Sciences Research. The content is solely the responsibility of the authors and does
not necessarily represent the official views of the National Heart, Lung, And Blood
Institute or the National Institutes of Health.
To learn more about the Nashville Collaborative and to watch a video,
visit childrenshospital.vanderbilt.org/nashvillecollaborative.
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“Daddy has a chance to join the Avengers.”
that’s how John “Jay” Wellons III, M.D., MsPH, explained to his 7-yearold son, Jack, why the family was moving to nashville, comparing the
Monroe Carell Jr. Children’s Hospital at vanderbilt to Marvel Comics’ league
of superheroes.
It was a metaphor the boy could get on board with (his reaction was
“ok, let’s go!”), but for young patients who need brain surgery, Wellons,
the new chief of Pediatric neurosurgery, truly is a superhero.
With high-tech gadgets, tremendous smarts, keen senses and incredible agility and speed, Wellons isn’t faster than a speeding bullet or able to
leap tall buildings in a single bound. but he is an expert in hydrocephalus,
brain tumors, brachial plexus nerve injury and minimally invasive endoscopic procedures.
Wellons brings national research networks that will allow Children’s
Hospital to expand not only in scientific discovery but in the daily clinical
care of children with neurosurgical problems. While he prefers to spurn the
limelight like Peter Parker or Clark kent, his ultimate goal has always been
working for the good of children.
John Wellons III, M.D., MSPH, is
chief of Pediatric Neurosurgery
at Monroe Carell Jr. Children’s
Hospital at Vanderbilt.
09
Like
the origin story of most superheroes, Wellons didn’t understand or want his medical superpowers at first. In high school
and college, he tried to make himself an English professor, but
kept up his pre-med courses just in case. In medical school at
the University of Mississippi, he thought he would be a smalltown family medicine doctor, “getting paid in chickens and
having plenty of time to write,” but he kept being drawn to OR
16, where the neurosurgery procedures were taking place.
“I was the guy in the anatomy lab spending hours there on
a Saturday while I could hear people cheering at the football
game across the street and I’m up there dissecting the sciatic
nerve. I just thought it was fascinating,” he said.
The native of Mississippi and a “child of the South,”
Wellons did his residency at Duke University and joined the
faculty at the University of Alabama-Birmingham (UAB), practicing at Children’s Hospital of Alabama.
One day Wellons’s mentor said he had a career game
changer—the Hydrocephalus Clinical Research Network
(HCRN).
Hydrocephalus, known as “water on the brain,” is caused
by abnormal accumulation of cerebrospinal fluid in the brain.
If too much fluid builds up, it can cause swelling, mental disability and death. The most common treatment is inserting a
shunt, or tube, that drains the excess fluid to other areas of
the body where it can be better absorbed.
A group of parents, philanthropists and physicians frustrated by the lack of research in hydrocephalus started the
HCRN to conduct nationwide studies. Children’s Hospital of
Alabama was one of the original sites in the network and
Wellons joined the HCRN executive committee.
“If you look at the number of patients being enrolled in
studies before the HCRN, it was about 67 a year. After the
network was formed it was around 670,” Wellons said. “The
annual incidence of hydrocephalus is actually higher than
pediatric brain tumors and slightly less than that of juvenile
diabetes. The cost is estimated to be over a billion dollars
10
SUMMER 2013
annually. It’s a much more common disease process than most
people think, and it’s not a one-size-fits-all disease.”
But like any great comic book star, Wellons first needed to
hone his skills—in the least superhero subject, statistics.
“I really had no idea when it came to the methodology and
analysis of it. They talked about chi square analysis and regression models and it was like the adult voice on Charlie Brown—
wah, wah, wah, wah.”
Wellons spent three years getting his Master of Science in
Public Health and says it fundamentally changed the way he
thought about neurosurgery.
“In classes we looked at large cardiology and asthma cohorts, and I realized that neurosurgery is a field that is technically advanced but statistically not so much. The HCRN is a
step in the right direction.”
The HCRN started enrolling patients around the country
in different research studies looking at ways to improve shunt
placement and longevity and ways to reduce shunt infections.
“We’ve reduced shunt infections by almost half through a
simple surgical checklist. We’ve standardized and improved
the care of premature infants with hydrocephalus. We’re looking at how patients are affected neuropsychologically by the
treatment they’ve had. It’s really a phenomenal list of things
and a remarkable thing to be a part of,” Wellons said.
“I think back to my mentor saying this was a game
changer and it absolutely was.”
When the offer came to move to Nashville and join
Vanderbilt, Wellons said it took a lot of soul searching because
his wife, Melissa Wellons, M.D., had a successful research career and busy endocrinology practice and they were reluctant
to uproot their two young children. But the opportunity to
grow the neurosurgery program won.
“There are a lot of clinical programs here that are ongoing
and excellent, like the fetal neurosurgery program here that
has been championed by Noel Tulipan [M.D., professor of
Neurological Surgery]. My goal is to look at the other areas
within pediatric neurosurgery and bring them up to that level
of excellence, all the while providing excellent clinical care and
field-leading or field-changing research.”
Vanderbilt’s Department of Pediatric Neurosurgery treats
a variety of neurological conditions, including brain tumors,
epilepsy, congenital and vascular malformations and spina
bifida, and maintains a robust research portfolio. It has been included in U.S. News & World Report’s “Best Children’s Hospitals”
specialty rankings. The department is a pioneer in performing
fetal surgery to improve the outcomes of children with spina
bifida, the most common birth defect of the central nervous
system. In 1999, Tulipan and colleagues published research
that demonstrated that babies who have corrective surgery for a
serious form of spina bifida (myelomeningocele) while still in
the uterus, experience a reduction in potentially life-threatening
hydrocephalus and have an increased ability to walk. That led
aNNE rayNEr
to a landmark, seven-year National Institutes of Health-funded
trial, called Management of Myelomeningocele Study (MOMS),
that tested the safety and efficacy of surgical repair and demonstrated clear benefits. During the study, Vanderbilt became a
nationwide destination for families seeking treatment. The trial
was halted early in December 2010 because the benefits of fetal
surgery were so significant.
Once at Children’s Hospital, Wellons immediately filled a
white board on his office wall with projects and ideas to build
on to an already successful program. He recruited two colleagues from UAB—Chevis Shannon, MBA, MPH, Dr.PH., who
is now the director of the Vanderbilt Pediatric Neurosurgery
Clinical Research Initiative, and Rob Naftel, M.D., a neurosurgeon who joins the faculty in August.
He implemented a protocol for the management of children
with traumatic brain injury, is expanding the brain tumor program, is working to join national research networks for Chiari
Malformation (a malformation of the brain) and syringomyelia
(a disorder in which a cyst forms within the spinal cord), and
continues to serve as primary investigator for a multi-center
study on shunting outcomes in post-hemorrhagic hydrocephalus
Noel Tulipan, M.D., Kyle Mangels,
M.D., and Joseph Bruner, M.D.,
performed a pioneering surgery
on a fetus with spina bifida at
Vanderbilt University Medical
Center in 1998. The surgery
later became part of a sevenyear landmark study, which
ended in 2010.
(SOPHH). It compares outcomes of certain procedures
to help children have the best
outcome.
“It is amazing when you
go in one exam room and see a
child with a severe interventricular hemorrhage that had
a shunt and they’re like ‘Hey Dr. Jay! I got all As and Bs on my
report card!’ Then in the next room, same scenario and they’re
wheelchair bound and non-communicative. Is there something
that we can do as surgeons early on in the process to help get
them into the first group? We’re coming close to being able to
actually answer that question.”
Wellons says the overall goal of all of these projects is to
advance the field of Neurosurgery.
“We’re using large data sets of experience to turn around
and impact patients. That’s what you get at an academic medical center like Vanderbilt and this Children’s Hospital. That’s
not going to happen down the street. We want to be a field
changer and define the direction that the field goes.”
11
12
SUMMER 2013
DaNIEl DUboIS
At 6 feet 5 inches, Braden
Parsons was made to play basketball. Sidelined temporarily
by hydrocephalus, an innovative
neurosurgery performed at
Monroe Carell Jr. Children’s
Hospital at Vanderbilt helped
him get back on the court.
What
does it
look like?
Shown are two different views of an MRI scan
of Braden Parson's brain that revealed he had
hydrocephalus. The white area shows the brain's
ventricles, which in Braden’s case were enlarged
with too much cerebrospinal fluid. The fluid
compresses the brain tissue inside the skull.
One of those new directions is an alternative to shunts in
treating hydrocephalus. In a procedure called endoscopic third
ventriculostomy (ETV) a small hole is made to create an internal bypass to drain excess fluid. Because no foreign hardware
is left behind, infections and maintenance are reduced.
At UAB, Wellons and Naftel used a tool called the Canadian ETV Success Score to evaluate the success of patients
treated with ETV to validate the procedure’s good outcomes.
“Shunts have done a lot of good, but families are now
coming to me and saying they really want an ETV. Now I can
look at their age and reason they have hydrocephalus and
show whether they will be successful or not and whether it is a
good procedure or not. It’s about personalizing it or selecting
the right patient.”
Sixteen-year-old Braden Parsons knows a thing or two
about criteria like that. At 6 feet 5 inches, his family says God
made him for basketball. He was also the perfect candidate for
ETV surgery.
The rising junior at Columbia Academy in Columbia,
Tenn., was at basketball camp in June 2012 when a fierce play
resulted in a concussion. Scans at Maury Regional Medical
Center revealed hydrocephalus, not related to the concussion.
Braden hadn’t shown any of the typical signs of hydrocephalus
and was referred to Children’s Hospital for more evaluation.
“I had never heard of hydrocephalus. I couldn’t get cell
service in the hospital so I ran to my van outside to Google it,”
said Braden’s mom, Christie Parsons.
“We went to see Dr. (Noel) Tulipan and he said there was this
great new doctor coming and we wanted him to do the surgery.”
Tulipan, professor of Neurological Surgery, explained the
ETV procedure and Christie Parsons’s Googling continued.
“My husband and I actually watched a video of the surgery
on YouTube and I was scared to death. I don’t like any medical
stuff but I wanted to see exactly what my child has to go
through,” she said.
“In the end, after talking with Dr. Wellons, we were super
comfortable. Our first question to Dr. Wellons was if Braden
could play basketball.”
“I really try to get kids back to being kids, playing appropriate sports, and having a healthy a lifestyle as possible. It
was clear to me that being active was important to Braden, so
we talked about it up front in addition to the surgery and what
to expect,” Wellons said.
“We have a fantastic team and our Nurse Practitioner,
Haley Vance, really goes the extra mile to make families and
children feel comfortable with the whole process.”
Braden had ETV surgery on a Thursday in October, only
took a few Tylenol afterward, and was back to school on Monday showing off his scar.
“I wanted to take two weeks off just to be off school but I
felt back to normal and wanted to see everyone. I also didn’t
want to deal with the make-up work,” Braden said. “I felt 100
percent like it never happened.”
Braden was sidelined from basketball until January and
Wellons says he should shy away from football, but at his
height, he isn’t too worried about taking elbows on the court.
Dedicated to his youth group at West 7th Church of
Christ, Braden spent his spring break in Mexico serving at an
orphanage and plans to go Freed-Hardeman University in
Henderson, Tenn., to become a youth minister.
“This was an unexpected event in our life but it went very,
very, very smoothly,” Christie Parsons said. “It was a speed
bump where it could have been a major life changing event.”
13
14
SUMMER 2013
Infectious
teamwork
Doctors and nurses raced to place two tubes, each
nearly the size of a garden hose, in 4-year-old Jasie Musick’s neck and leg vessels to connect her to a life-support machine at Monroe Carell Jr. Children’s Hospital at
Vanderbilt. She was drowning in her own fluid-filled
lungs, overwhelmed by a bacterial lung infection.
Hours earlier, doctors in her hometown of McMinnville, Tenn., had diagnosed Jasie with influenza type B, a bug that was hitting children particularly
hard this year. An X-ray proved Jasie had developed more than just the flu. A
smoldering bacterial pneumonia was already unstoppably building in her
small lungs.
This kind of worst-case scenario was the result of a rare, but very real side
effect in the wake of a seemingly simple case of the flu: she had developed a
bacterial infection on top of severe influenza.
Jasie was succumbing to her own body’s attack on the bacteria Staphylococcus aureus (staph), which normally cannot find a foothold within the lungs;
but in the wake of an influenza illness, can quickly consume them, in even the
healthiest of individuals, especially if they are unvaccinated. Jasie had not had
a flu shot.
written by Carole bartoo
photograph by Daniel Dubois
15
“She
was on the stretcher at the
emergency department at River Park (in McMinnville) and was
giving some sass about what she would do to the next doctor
that wanted to poke her with a needle,” recalled her father,
Jason Musick. “en just a couple of hours later she was on life
support.”
Understanding infectious diseases, such as influenza, and
how to diagnose, treat and prevent them is at the core of many
research projects underway at institutions including Vanderbilt, home to some of the top pediatric infectious disease experts in the world. With the highest level of intensive care, a
deep bench of specialists and teamwork at Children’s Hospital,
these physician-scientists are busy tackling age-old mysteries
to help prevent and treat illnesses.
Jasie’s case highlights the comprehensive combination of
teamwork, research and prevention efforts happening at Vanderbilt to fight these aggressive diseases.
In previous decades, bacterial infections – like Jasie’s –
would have been the cause of death in millions of otherwise
healthy children and adults after a bout with the flu.
Today “secondary infections” are much rarer because of the
influenza vaccine, but they continue to take lives. This year a nationwide spike of 110 pediatric flu-related deaths were reported
by April 1, compared with 34 the previous year. But the worst
year in recent history was 2009-2010, the year of the H1N1 pandemic, when 228 children died along with many more adults.
The pattern is strikingly similar. In most cases, the child is
healthy, although most are unvaccinated. By all appearances, it
starts as a routine case of the flu, then after about four days,
DaNIEl DUboIS
the pediatric infectious disease team includes (from
left): Derek Williams, M.D., kalpana Manthiram, M.D.,
kathryn edwards, M.D., and buddy Creech, M.D., MPH.
16
SUMMER 2013
instead of getting better the child suddenly gets worse. There
may be breathing difficulties, chest or stomach pain, nausea
and vomiting, then rapidly progressing illness.
Pediatric Infectious Disease Fellow, Kalpana Manthiram,
M.D., witnessed several cases during her first year of fellowship of what could be described as a “the worst of the worst” in
flu cases. Jasie’s was among them.
“Nothing can really prepare you for the speed at which
these infections act. It’s kind of incredible,” said Manthiram.
‘A very sick little girl’
The Musick family opted out of the flu shot for their children. They were all strong and healthy and they had heard it
was better to let healthy children deal with illnesses like the
flu on their own. And year after year they experienced the flu
and recovered just fine. But this time, Jasie’s parents knew it
was different.
“She had already been through the flu once last year, in
December,” said her mother, Brittany Musick. “But this second
time the fever just kept on.”
They took her to River Park Hospital in McMinnville,
Tenn., on March 5. Her father, Jason Musick, captured cellphone video of his scrappy middle child and only daughter
hours before she fell critically ill. About the same time an Xray revealed a white shadow over a part of her lung where fluid
was collecting.
River Park staff made an urgent call for Children’s Hospital’s Angel Transport ambulance to bring her to Vanderbilt.
Jasie had fallen unconscious and was critically ill.
The ambulance attendant would later tell Jasie’s mother
Brittany he had to use all three blood pressure drugs he had on
board, for the first time ever, to keep her blood pressure at a
life-sustaining level.
She arrived at Children’s Hospital blue-skinned and taking
rapid shallow breaths. An X-ray showed the shadowy white
had spread to both lungs and was creeping upward. Over the
next two hours, the infection and inflammation spread to
every space of Jasie’s lungs. Doctors put her on a heart-lung
support machine called ECMO (Extracorporeal Membranous
Oxygenation). The X-ray taken at the time she was placed on
ECMO showed no discernible, “black-and-breezy” spaces at all
where Jasie’s lungs should be.
“Everything was done right in this case,” Manthiram
stresses. “From how quickly her parents brought her in, to the
outside hospital starting her on appropriate antibiotics, to getting her here quickly and on ECMO. It is just the interplay of
factors we don’t completely understand. But, we know that the
influenza vaccine can help prevent these severe infections.”
Brian Bridges, M.D., assistant professor of Pediatric Critical Care and Medical Director of the ECMO team, recalled getting a call from the Angel ambulance team transporting Jasie
on the morning of March 5. The Angel team, made up of
nurses with years of critical care experience, requested from
the road that the hospital prepare to assess Jasie for ECMO.
“That is very rare. She was a very sick little girl,” Bridges
said.
ECMO Surgical Director, John Pietsch, M.D., associate
professor of Pediatric Surgery, said secondary infections after
influenza are as dangerous for the impact of the immune response as the bacterial or viral infection itself. He says the reason children like Jasie can “crash” so quickly is that the
chemical responses of the immune system take over the body’s
throttles. Heart rates rise, and people breathe harder, while at
the same time, vessels all over the body open up, or dilate.
“They are like a radiator, opening up blood vessels, so
blood pressure begins to go down at the same time as their
heart rate goes up. We have good medications to help control
these things, but sometimes the patients are more potent in
their body’s response than even our medicines can control.”
Pietsch said.
Brittany Musick said Jasie swelled with frightening speed,
her tiny neck disappeared as her chin swelled down to her
chest and her eyelids puffed out like a boxer’s. The swelling
and fluid in her lungs were so severe, a very new technique
was applied to the ECMO machine called continuous dialysis.
“It allows us to gradually pull fluid off of these very sick
patients. This way she wouldn’t have the extreme ups and
downs of periodic dialysis treatments,” Bridges said.
As one of the largest and most experienced ECMO centers
in the country, and one of the few that offers continuous dialysis with it, Vanderbilt’s survival rates are about 10 percent
higher than most other ECMO centers. An estimated 50 percent-60 percent of patients like Jasie will survive. But in the
end, doctors say all that ECMO, the team of intensivists, specialists and even the pediatric infectious disease experts can
do is support the body’s efforts to heal itself.
“Fifteen years ago, these kids would have died. But they
were healthy before all this, so if we can bridge them through
their illness and organ failure, they have a good chance to recover fully, and grow up and have a life and kids of their own.
When we see this happen, it’s almost magical,” Bridges said.
For Jasie, it was after her eighth day on ECMO that her
body began to show signs it could support itself again. By
March 25, she was off the ventilator, breathing on her own. By
April 1, she still needed a little bit of dialysis to support her
kidneys, but she resumed talking and playing and watching
puppy videos on her mom’s iPad.
Studying the evidence
Theories and research projects are addressing many lingering questions. One of them is why the flu is particularly
well-suited to set healthy people up for secondary infections.
Second case spurs
discussion, new projects
to try to save lives
In March, 14-year-old Miles
Freeman and 4-year-old Jasie
Musick were in side-by-side
intensive care unit rooms
being treated for viral
pneumonia with a bacterial
lung infection stacked on top,
a “bacterial superinfection.”
The Freeman family offered
advice to the Musick family
about ECMo (Extracorporeal
Membranous oxygenation),
the top level of life-support
technology, when Jasie was
also placed on ECMo. The
families became close, but
on March 10, Miles died. a
little more than a month
later, Jasie would leave the
hospital, on her way to a full
recovery.
Why one young patient
dies while another, with a
seemingly similar disease,
lives is the sort of question
that keeps intensivists like
Geoffrey Fleming, M.D.,
assistant professor of
Pediatric Critical Care, up
at night.
“The day after Miles died
I was on the phone with my
ECMo mentor in Michigan.
I called her because it was
frustrating. Miles was in the
bed next to Jasie in the
Pediatric ICU, but he was
dying, and Jasie was going to
get better,” said Fleming.
one obvious difference
was that the bacteria causing
Jasie’s superinfection was a
type of Staphylococcus that
still responds to older
therapies, called MSSa
(methicillin-sensitive
Staphylococcus aureus).
Miles was infected with
the increasingly common
resistant, and harder to
treat, strain of staph, called
MrSa (methicillin-resistant
Staphylococcus aureus).
“MrSa was the obvious
difference, but we had other
patients who have had bad
MrSa and got better,”
Fleming says. “So why
couldn’t we get Miles better?”
Now Vanderbilt physicians
and others around the country
hope to convene a small
group study to look carefully
at cases of influenza with
superinfection. They will
connect through the
nationwide Extracorporeal
life Support organization
(ElSo) to discuss how this
study might be developed.
“We want to see if there
are variables we can identify
early on in these illnesses.
The hope is when we get the
Miles Freemans and Jasie
Musicks, can we find a way
to change those modifiers.
Maybe it will make the
difference between death
and survival,” said Fleming.
– by Carole Bartoo
17
“The flu and staph together create this worst-case scenario,” said Buddy Creech, M.D., MPH, assistant professor of
Pediatric Infectious Diseases and one of Manthiram’s mentors.
Creech explains that a bad case of influenza has a way of
stripping the lining of the whole respiratory tract, from the
nose to the bottom of the lungs.
“The hair-like cells that normally sweep bacteria out of
the lungs are gone, and the lungs are unprotected,” he said.
The staph bacteria that usually live quietly inside our
noses or on our skin, can smolder, flare and begin to get a
foothold lower in the respiratory tract. In cases like Jasie’s, the
infection spreads throughout the lungs, whipping up a massive reaction of the body’s immune system over the course of
just a few hours or days.
“We also know that when we get influenza our immune
response is slanted in such a way that it might reduce our ability to fight bacterial infections that might occur on its heels,”
Creech said.
Creech’s research focuses on staph infections. He and
other Vanderbilt researchers are helping build evidence that a
significant amount of damage can come from an overreaction
of the immune system when it detects Staph. One theory is
that some individuals lack the genetic “brakes” each person
should have to temper an immune response, putting some
people at higher risk for these life-threatening infections.
But even in normal immune responses, bacteria and
viruses each have the ability to wreak havoc on their own. Take
the toxin PVL (Panton-Valentine leukocidin), produced by certain strains of Staph. Studies show it has the power to literally
“eat” or melt away tissues of the lungs. And research underway
now at Vanderbilt and elsewhere is finding evidence to clearly
describe the devastating role viruses have in pediatric hospitalizations for pneumonia.
In additional research, Derek Williams, M.D., MPH, assistant professor of Pediatrics, is working with a team on the
“Etiology of Pneumonia in the Community” or EPIC study.
The multi-institutional study has enrolled 5,000 children and
adults who were hospitalized with community-acquired pneumonia between 2010 and 2012. When the work is complete,
Williams says it will show that most children in the study had
Community physicians key to prevention efforts
The role of community physicians is critical
in the global effort to reduce childhood illness
through vaccination. Vaccine researcher
Kathryn Edwards, M.D., the Sarah H. Sell and
Cornelius Vanderbilt Professor in Pediatrics
and director of the Vanderbilt Vaccine research
Program (VVrP), says community physicians
make critical research possible in both the development of vaccines and the evaluation of
their effectiveness.
Edwards says the first 20 years of her vaccine research at Vanderbilt took place mostly
through local pediatricians’ offices, where she
and her colleagues tested everything from the
whooping cough vaccine early in her tenure to
the nasal spray flu vaccine in just the last
decade.
“It has been one of the most rewarding parts
of my career. My greatest hope is that in this
new, more complex, and challenging era of
health care that this excellent spirit of collaboration will continue to be strong. We have
several studies right now that come from
community evidence to inform the effectiveness of vaccines,” Edwards said.
one current project examines a vaccine’s impact on secondary illnesses, like pneumonia.
both the influenza and pneumococcal vaccines
18
SUMMER 2013
impact development of many infections with
these germs, but it is not yet clear the extent to
which they can specifically prevent the development of pneumonia. Carlos Grijalva, M.D.,
MPH, assistant professor of Preventive Medicine, and Marie Griffin, M.D., MPH, professor of
Preventive Medicine and Medicine, are looking
at community vaccination records of children
and adults to determine the effectiveness of
vaccines for both influenza and pneumonia in
preventing health care visits for pneumonia
and other respiratory illnesses.
“research of this type takes a lot of effort
on the part of the community practitioners,”
Edwards said. “They have to consider how
they document things, look up charts and
send them to us, and that can take quite a bit
of time. They have been very understanding,
and we depend on the excellent quality of
the work they do in giving and documenting
vaccinations. This is pivotal to answering basic
questions about how vaccines are doing in
preventing disease,” Edwards said.
as the largest and most comprehensive
Vaccine Center in the region, Vanderbilt
commonly partners with public health entities
like the U.S. Centers for Disease Control and
Prevention (CDC) and local and state health
departments on projects. a large CDC-led
project, in coordination with the medical
director of Tennessee’s Immunization Program,
Kelly Moore, M.D., MPH, is working to get
more community physicians involved in vaccine safety. The project, called the Vaccine
Safety advice Network (VSaN), is a pilot
project utilizing Vanderbilt physicians in the
vaccine research program to quickly answer
vaccine safety questions from the pediatricians’ offices.
“If any pediatrician has a question about a
patient reaction to a vaccine, or vaccine safety,
they email the VSaN system, and that alerts us
to pull our experts together to examine the
question and provide an answer within 24 to
48 hours,” Edwards said.
The collaborative work of pediatricians and
other physicians from primary care clinics all
over Middle Tennessee is essential to the work
of Vanderbilt’s vaccine programs. Edwards said
they also make it possible for their patients to
be part of the same critical work that will continue to find answers to prevent serious childhood illness.
DaNIEl DUboIS
at least one virus detected, including influenza, but also respiratory syncytial virus (RSV), Human Metapneumovirus
(HMPV) and others.
EPIC closely examines what viruses and bacteria can do
together.
“With studies like EPIC, we are beginning to learn more
about how viruses interact with bacteria to cause bacterialviral co-infections which are often more severe than either bug
alone. However, it also highlights a problem we have right
now, which is detecting possible bacterial-viral co-infections
early before children become extremely ill,” said Williams.
He explains that while viruses are readily detected from
nose or throat swabs, methods for reliably diagnosing bacteria
are lacking. So, it’s possible bacterial co-infections are seriously underreported in children. Williams said work is underway to develop improved diagnostic testing for pneumoniacausing bacteria including a rapid urine test and a blood test.
Early detection would allow for effective therapy for those
with bacterial pneumonia, and prevent unnecessary tests and
treatments for those with viral disease. However, more research needs to be done before any new tests will be ready for
general use.
Prevention is key
Creech and the team are also focusing on the development
of better flu vaccines as well as a possible vaccine for staph to
help prevent these overwhelming infections.
“We know the influenza vaccine can prevent these severe
cases, but the truth is, it’s not a 100 percent guarantee,” he
said.
Several versions of a Staphylococcus vaccine have been
tested with steadily improving results, although a marketable
vaccine is still likely several years away.
In regards to influenza, he says a “universal” flu vaccine is
the holy grail of influenza prevention. Instead of requiring an
annual flu shot, people might be able to get just one vaccination and be protected, even against pandemics, for a prolonged
period of time, much like polio, mumps or rubella. Such a vaccine has shown promise in mouse models, and Vanderbilt is
one of the sites around the nation helping test new ways that
such a vaccine could be given.
Vanderbilt is also one of the major hubs for testing of
so-called “synthetic” or “DNA” vaccines, created using newer
technology for producing flu vaccines. Instead of growing the
virus in eggs and then killing the virus, a portion of DNA from
flu is put into harmless bacteria for replication. This allows the
vaccine to be made more quickly, more safely (avoiding egg
allergy concerns), and more reliably.
The effectiveness of the influenza vaccine is a bit of a
moving target. Every year, the vaccine is designed to fight
three strains of the flu likely to circulate during the season,
Jasie Musick, 4, with her mom brittany, is back
home recovering from a life-threatening case
of the flu and bacterial infection.
but it’s an educated guess. The U.S. Centers for Disease
Control and Prevention indicates the 2012-2013 flu season
vaccine reduced the risk of flu-associated medical visits from
influenza A (H3N2) viruses by 50 percent, and from influenza
B viruses by two-thirds for most of the population. That leaves
one-third to one-half the vaccinated population at some
degree of risk for this past flu season.
In Jasie Musick’s case, it’s hard to know for sure whether
her illness might have been prevented with a flu vaccine. But
the Musick family says they have learned that as tough as their
children may be, the flu can be much tougher.
Jasie is back home now and should recover fully. Her
mother says she’s already back to her sassy-self, throwing her
arms up in frustration and saying, “I told you!” when people
can’t quite understand her hoarse, post-ventilator voice. She is
certainly as spirited as she was before this experience which
her grateful parents take to be an excellent sign that she will
be back on schedule to start kindergarten in the fall.
“I know I will be taking illness more seriously,” Brittany
Musick said. “They will definitely get their flu shots every
year. We never want to have to go through this again.”
19
Raising
Miracles
CELEBRATING 30 YEARS OF THE CHILDREN’S MIRACLE NETWORK HOSPITALS ®
written by Christina Echegaray
photograph by John russell
Dalton Waggoner is a real boy with a real story.
While a life-size advertising campaign cutout of a smiling Dalton stands
erected inside more than 70 Daily’s/twicedaily convenience stores across
Middle Tennessee, he’s not a child actor or model – though certainly cute
enough to be.
The 8-year-old third-grader from bowling Green, Ky., lends his story,
ear-to-ear grin and cheery disposition to a cause he holds dear to his heart:
Monroe Carell Jr. Children’s Hospital at Vanderbilt and the Children’s
Miracle Network Hospitals (CMN).
20
SUMMER 2013
21
For four years now, Dalton
has been the face of the
Children’s Miracle Network
campaign at Daily’s stores,
helping raise money for Children’s Hospital, where he has
visited many times since birth for doctors’ appointments and
procedures for his heart and other conditions. At the stores,
customers can purchase a paper icon of a balloon for a dollar,
which is donated back to Children’s Hospital.
“I never tell our story for someone to feel sorry for our son
or our family. I tell it only to give hope to other families and to
help the staff at Children’s Hospital know that no matter what
their position is, their role makes an impact on a family,” said
Susan Waggoner, Dalton’s mom. “I also think it is great for people in the community to see that there are real patients who are
grateful for their donations and the difference they make.”
In 1983, 20 hospitals from across the nation banded together to help children like Dalton. Vanderbilt’s children’s
Did you know?
Children’s Miracle Network Hospitals is the only national
children’s charity committed to have 100 percent of the funds
raised stay local to support local children. CMN hospitals…
-
22
Treat more than 17 million patients each year
Treat 98 percent of all children needing heart or lung
transplants
Treat 88 percent of all children with cancer
Treat 76 percent of all children with cystic fibrosis
Treat 90 percent of all children with sickle cell anemia
Treat 72 percent of all children with pediatric aIDS
Train 60 percent of all pediatricians and 80 percent of
pediatric specialists
Educate families and communities about issues like child
safety seats, bike helmets and bicycle safety
Provide $2.5 billion in uncompensated care each year
SUMMER 2013
hospital was one of those founding members of an organization
called Children’s Miracle Network Hospitals.
e common goal of the network was to save the lives of
children by raising funds and awareness for children’s hospitals,
and served as a sort of “Good Housekeeping seal of approval”
for member hospitals. Actor John Schneider, of the Dukes of
Hazzard, and singer/actress Marie Osmond co-founded CMN,
and working with a dedicated team of children’s hospitals, television stations and sponsors ran a televised fundraiser that year
to help communities support their local pediatric institutions.
“Vanderbilt’s children’s hospital and the Nashville market
were very important to us for two major reasons. First, the
stellar reputation of the hospital and the national presence
the hospital has. Second, we were doing a national telethon
that was going to use entertainers to perform and be our
‘messengers’ of the CMN mission,” said Joseph G. Lake, also
a co-founder of CMN, now retired.
“We wanted Los Angles and we wanted Nashville, and
thanks to your hospital and your willingness to join us, as L.A.
did, we hit it out of the park.”
Located in Salt Lake City, Utah, the international non-profit
CMN has grown to 170 children’s hospitals over three decades.
Since Vanderbilt joined the partnership 30 years ago,
more than 70 community and corporate partners across 48
counties in Middle Tennessee and southern Kentucky have
raised more than $25 million solely for Children’s Hospital
through CMN. Funds raised locally remain in the community
to support local children’s needs at the hospital.
“It is inspirational to see the support of our many community partners,” said Luke Gregory, chief executive officer of
Children’s Hospital. “Our affiliation with Children’s Miracle
Network Hospitals shines a light on the impact of combined
efforts for a common cause.”
Much of the money raised through the organization comes
from the sale of paper balloon icons—stamped with the signature CMN and Children’s Hospital logos—at local partners’
SUSaN UrMy
stores, including Walmart, Daily’s, Great Clips, Ace Hardware,
Jersey Mike’s, area credit unions, among many others. e
partners also place coin canisters in their stores for customers
to voluntarily drop off the loose change from their pockets.
Making a big impact on lifesaving care for children, 19
CMN partners account for almost $20 million of the total
support over the years, with Walmart the most committed
partner at $6.2 million and counting. WTVF NewsChannel5
(Telethon), Clear Channel Media (Radiothon), Vanderbilt
University Dance Marathon and Daily’s round out the top five.
Total CMN support from Daily’s, where’s Dalton’s face is
seen far and wide, has reached nearly $1.2 million in 10 years.
ey are a committed, ongoing partner.
“Our company is dedicated to our community, and we
work to make a difference. Our support of Children’s Hospital
is the perfect opportunity to do just that and help our customers—who are also our neighbors—have the chance to
support a place that is critical to our children’s well-being,” said
Steve Hostetter, chief executive officer of Daily’s Convenience
Stores and Children’s Hospital Board member.
“To have such an enthusiastic partner in the Waggoner
family makes all the difference.
Dalton Waggoner has parDalton is a real-life example of how ticipated in many Children's
Children’s Hospital impacts our
Hospital events over the
lives. His image and story provide a years. Here, at age 5, he
plays on an inflatable slide
clear understanding of what we’re
at a We Care for kids Day
supporting.”
celebration.
e Waggoner family never imagined they would need to
access the care at Children’s Hospital. ey had driven by the
brand new, freestanding children’s hospital several times after
it opened in February 2004—seven months before Dalton
was born.
“If you never have to walk into (the hospital to access
services for your child) as a parent or grandparent or family,
you’re lucky; we were just that before Dalton was born,” said
Susan Waggoner. “It was a beautiful building on the outside,
but it was a truly amazing building when we had to be there.”
Dalton was born eight weeks premature, but was doing
well enough that he didn’t have to be placed in the Neonatal
Intensive Care Unit. Initially diagnosed with a heart murmur,
an appointment with a cardiologist at Children’s Hospital just
hours after the Waggoners left the maternity ward alerted
them it was far more serious.
“We left the delivering hospital thinking we were going
home this happy, healthy family—or so we thought. e cardiologist told us Dalton may have one to six hours before he
could go into cardiac arrest,” Susan Waggoner said.
Doctors diagnosed the infant with a congenital heart defect
called unicuspid aortic stenosis, characterized by a narrow heart
valve that doesn’t allow the heart to pump blood properly. In
Dalton’s case, his valve was completely closed. At 3 days old
and weighing 5 pounds, Dalton had his first heart procedure.
Doctors did not know if he would survive the week.
In addition, he was also diagnosed with ectodermal
dysplasia, which means he has no hair and his body cannot
regulate its temperature, such as sweating when he’s hot.
Fast forward eight years, Dalton is a thriving, third-grader
who loves video games and sports, though he is not allowed to
play most of them because of his conditions. He will need
open heart valve replacement surgery throughout his life because the replacement valve he has will not grow with him.
He’s busy giving back to the hospital where he has spent
so much time. When he enters a Daily’s store, customers and
employees are always shocked to see him.
“‘He’s real,’ we always hear people say. Dalton thinks it’s
funny,” said Susan Waggoner. “We’ve always taught our children to give back to others—Dalton taught us not to take
things for granted. At this stage in Dalton’s journey—and it is
just that, a journey—we are able to give back to the hospital
that has given our family so much.”
Dozens of families have shared their stories over the years
for the Children’s Miracle Network. Families impart their
heartwarming and inspiring tales of strength, faith and familycentered care in campaigns for other stores and at events such
as the Children’s Miracle Network telethon held every year on
the first Sunday in June on Nashville’s NewsChannel 5. ere’s
also Miracle Jeans Day which allows employees to donate $5 to
be able to wear jeans to work one day. On IHOP National
23
Pancake Day people can make a suggested donation for a free
stack of pancakes. And the event list is growing every year.
e family stories make it easy for CMN partners to get
on board. Marriott is the longest tenured partner—joining
CMN 30 years ago. Walmart has been involved for 25 years.
“At Walmart, we believe we can make a difference in
communities across the country by supporting charitable
organizations that help people live better,” said Shana BaileyDeSmit, the retail store’s senior director regional general
manager. “rough the work of Children’s Miracle Network,
each year millions of sick children find comfort, treatment
and hope. ese children and their families often live in the
communities we serve, the communities our customers and
associates call home. We are proud to support their efforts
and pleased with the enthusiastic involvement that our associates have shown.”
e associates that work for Walmart take personal ownership of the campaign, making it fun while supporting a good
cause. Margaret C. Pardue, who works at a Paris, Tenn., Walmart,
even takes on a different personality for the Walmart campaign
in May and June. She’s no longer “Margaret.” Instead, she’s the
“
Through the work of Children’s Miracle
Network, each year millions of sick children
find comfort, treatment and hope.
“Crazy Hay Lady.” It should be “hat,” but a computer typo on the
sign attached to her first-ever hat asked people to help her raise
money for CMN to “get this hay off my head.” People have donated with enthusiasm for more than two years, and Pardue has
personally raised more than $4,000 for CMN. So “crazy hay”
stuck. is year, her goal is to raise $2,000.
“I have a niece and nephew, and my nephew wouldn’t be
here today if it wasn’t for Vanderbilt; he’s 20 now,” said Pardue.
“It’s a great hospital, and there are special children out there
that need our help because they are sick.”
Children’s Miracle Network
Partners in Our Region
aCE Hardware
austin Peay State University
Dance Marathon
belmont University Miracle Makers
bPoE lodge 2156
bruegger’s
Capitol Wholesale Fence Co.
Carmike Cinemas
Chico’s FaS
Coca-Cola
24
SUMMER 2013
Costco
Credit Unions 4 Kids:
ascend Federal CU
Cornerstone Financial CU
Electric Service CU
Fort Campbell Federal CU
Nashville Firemen’s CU
old Hickory CU
US Community CU
Daily’s / twicedaily
Dairy Queen
Dunkin’ Donuts
Enterprise
Feld Entertainment
Food lion
Foresters
FrED’s
Great Clips
Greek Partners:
Phi Delta Epsilon
Phi Kappa Theta
Phi Mu
Sigma alpha Epsilon
Sigma Chi
Zeta beta Tau
Guy brown Products
Honeysuckle Hill Farm
IHoP
Jersey Mike’s Subs
Kroger
laSH
long John Silver’s
love’s Travel Stops &
Country Stores
Malco Theatres
Marriott International
Martin Methodist College
Miss america / Miss Tennessee
Nashville Swim league
Panda restaurant Group
Performance Scrubs
Portland High School FFa
Publix
Purity
rE/MaX Choice Properties
rE/MaX Elite Properties
rite aid
Sewanee Fire Department
Standard Coffee / DS Waters
of america
Tennessee Trucking association
Valvoline Instant oil Change
Vanderbilt University
Dance Marathon
Walmart / Sam’s Club
White Castle
William Edge Salon & Spa
Williamson County Swim league
WMGC-aM 810 la Sabrosita
WrVW-FM 107.5 The river
WTVF (CbS) NewsChannel5
Children’s Miracle Network 20 Founding Hospitals
7
6
12
10
14
18
2
3
20
9
13
19
1
16
17
4
11
15
8
5
1 Monroe Carell Jr. Children’s Hospital at Vanderbilt
Nashville
11 Children’s Hospital of Alabama
Birmingham
2 James Whitcomb (Riley Children’s Hospital)
Indianapolis
12 St. Luke’s Children’s Hospital
Boise
3 Johns Hopkins
Baltimore
13 UC Davis Medical Center
Sacramento
4 Children’s Hospital Los Angeles
Los Angeles
14 Children’s Hospital
Columbus
5 Miami Children’s Hospital
Miami
15 Shands Jacksonville Medical Center
Jacksonville
6 Children’s Hospital of Eastern Ontario Foundation
Ottawa, Canada
16 East Tennessee Children’s Hospital
Knoxville
7 Gillette Children’s Specialty Healthcare
St. Paul
17 Arkansas Children’s Hospital Foundation
Little Rock
8 All Children’s Hospital
St. Petersburg
18 Primary Children’s Hospital
Salt Lake City
9 Children’s National Medical Center
Washington, D.C.
19 Children’s Medical Center Foundation
Tulsa
10 William Beaumont Hospital
Detroit
20 Children’s Medical Center
Dayton
25
pioneers
f hope
Hernán Correa, M.D., chief of Pathology at Monroe Carell
Jr. Children’s Hospital at Vanderbilt and medical director of
the Division of Pediatric Pathology, inherited two things from
his father: a desire to be a pathologist and a heart for children.
Correa grew up in Colombia and spent weekends on the
family’s farm, tending gardens, chickens and cows, and riding
horses to the nearby village where his father, also a pathologist, volunteered to treat the locals’ tropical diseases.
“He would show us the parasites or explain how a person
gets these worms in their intestines. Medicine was always
around, and I never thought about being anything else but a
doctor,” Correa said.
In 1970, the family traveled to the United States for
Correa’s father to continue his cancer research at the National
Institutes of Health. What they thought would be a sabbatical
year turned into a permanent move when communist guerilla
fighting made it too dangerous to return home.
Correa, however, always wanted to return to Colombia
and attended medical school at Universidad del Valle, where
his father and grandfather had both been professors.
During residency at Louisiana State University and Children’s Hospital of New Orleans, Correa discovered the exciting
new subspecialty of pediatric pathology, which combined his
love for pathology with his desire to help children. After a fellowship at British Columbia’s Children’s Hospital in Vancouver,
Correa returned to New Orleans to practice for 14 years.
In the aftermath of Hurricane Katrina, Correa looked for
new opportunities for growth and learned that Vanderbilt
needed a pediatric pathologist for the Children’s Hospital. At
the time, all pathology was located at Vanderbilt University
26
SUMMER 2013
n
H e r n á M.D.
A,
C o r r e ology
Path
SUSaN UrMy
At the Monroe Carell Jr. Children’s Hospital at Vanderbilt, our physicians’ work extends
beyond patient exam rooms. They are also searching for discoveries to offer better
treatments, and hopefully, find cures for their pediatric patients. The four doctors profiled
here represent only a sampling of the physicians working tirelessly to make Children’s
Hospital a place of unwavering hope.
– by Leslie Hill
•••
Gretchen Purcell Jackson, M.D., Ph.D., vividly recalls
her days as the chief resident on the pediatric surgery service
nearly a decade ago.
e regime, which called for her to be available 24/7,
meant she slept on the floor of her office between cases and
spent more time at the hospital than anywhere else. It was a
grueling routine, but Jackson loved it.
“When I did pediatric surgery as a fourth-year resident, I
just fell in love with it. I loved every minute on the service.
“I pretty much always wanted to be a doctor and a surgeon, especially after my heart surgery when I was 10 years
old. I think being a patient who has spent a lot of time on the
cold end of the stethoscope makes me a better doctor. “
Diagnosed with pulmonary stenosis when she was 6
months old, Jackson underwent a pulmonary valvuloplasty to
repair the condition that caused the flow of blood from her
heart to her lungs to be slowed by a deformity on the pulmonary valve.
Gr etCH en
Pu rC eL L
JACk so n,
M.D., PH.D.
Pediatric
Surgery
SUSaN UrMy
Hospital, but as the complexity of the patients seen at Children’s
Hospital increased, the need for pathologists specialized in pediatric cases became evident. Correa was brought to Vanderbilt
to lead the Pediatric Pathology division, which now has five
pathologists and welcomes its first fellow in July.
Pathologists are an important part of the care team, along
with clinicians and surgeons. A pathologist will evaluate body
fluids, like blood or urine, or thin slices of tissue to interpret
their changes and help make a diagnosis.
“e pathologist is the behind-the-scenes doctor,” Correa
explained. “I like being part of the patient care team. e clinicians and surgeons routinely join us in the review of the slides
and to discuss cases. Although pathologists may never see the
patient, we stay informed of their outcomes. I find this participation in their care a very rewarding experience.”
One of Correa’s research interests is eosinophilic esophagitis
(EE), a type of inflammation of the esophagus that may be allergic in origin. It usually causes heartburn, difficulty swallowing
and food impaction. He has developed a large database of pediatric esophagus biopsy samples taken in the last 15 years.
“I’m trying to decipher the different microscopic features
of the inflammation, looking for clues of its causes. I believe
there are many ways to get to this end result of EE. It could be
food allergies, environmental allergies, a genetic predisposition, or a combination of these, and understanding the different changes may help us pinpoint the cause,” Correa said.
Correa is married and has three daughters—a 16-year-old
and 13-year-old twins. ey have inherited his curiosity about
science and his love for soccer.
Jackson came to Monroe Carell Jr. Children’s Hospital
at Vanderbilt in 2006, where she is an assistant professor of
Surgery, Pediatrics and Biomedical Informatics. She graduated
from Stanford University with a B.A. in Electrical Engineering
and Biological Sciences in 1989, a medical degree in 1996, and a
Ph.D. in Medical Information Sciences in 1997. She completed
her residency at Duke University Medical Center in 2004,
followed by a fellowship in Pediatric Surgery at Children’s
Hospital of Pittsburgh.
She was drawn to Vanderbilt because “it was one of a few
places in the country where she could have a career as a surgeon, clinician and informatics researcher.” Vanderbilt houses
one of the largest informatics programs in the country and has
also pioneered work in the development of patient portals to
allow patients to interact with a health care system through
secure online applications. Vanderbilt’s Web-based system is
called My Health At Vanderbilt.
Jackson has several research projects related to My Health
At Vanderbilt. Her work focuses on empowering patients and
their families to take an active role in managing their health
by using communication technologies.
27
CrA,
sArI AMPH
.,
M.D
y,
nterolog
Gastroe logy and
to
a
H ep
n
Nutritio
28
SUMMER 2013
JoHN rUSSEll
Her team is currently evaluating the level of medical care
being delivered by patient and provider messaging through
the portal.
“Care is being delivered through our patient portal,” she
said. “We have been able to show that new problems are identified; complications and adverse effects of medications are reported; medications are adjusted; and new consultations and
referrals are made. ose online interactions between the patient
and medical team can be considered outpatient encounters, but
the patient does not need to drive to Vanderbilt.”
With the increased availability of information and technology to support patients in the management of their own
health, there is great opportunity, she said, for people to become healthier.
Jackson recently created a self-management tool for the
portal which allows patients to track health-related goals to
modify their diet, exercise and lifestyle. is tool has the potential to help patients with a wide variety of chronic health
conditions and to allow them to take responsibility for their
own health outcomes through behavioral adaptations, she said.
“My long-term goal is to provide patients and their families
with the information and tools to ensure that they are getting
the best care possible,” Jackson said. “At Vanderbilt, there is
such emphasis on personalized medicine and these tools can
help us deliver truly individualized care.”
When not in doctor/researcher mode, Jackson enjoys outdoor activities with her husband, Heath, and two daughters,
Brynn and Olivia.
– by Jessica Pasley
•••
sari Acra, M.D., MPH, chief and medical director of the D.
Brent Polk Division of Gastroenterology, Hepatology and Nutrition at Monroe Carell Jr. Children’s Hospital at Vanderbilt,
has a newly discovered species of extinct insects named after
him called Chimerhachiberotha acrasarii.
Acra, his siblings and father unearthed Lebanese Amber
glass and found the 120-million-year-old insect imbedded
within. ey spent a lot of time excavating the amber, polishing
it and photographing the extinct bugs, collaborating with museums of world history from around the globe.
As an amateur archeologist, Acra enjoyed using his
hobby—archeology—to dig for information and the art of
research. It was that same sense of discovery, instilled by his
father decades ago, that drives his current medical research as
a pediatrician.
His work with partner Maciej Buchowski, M.D., in the
Human Energy Balance Lab at Vanderbilt focuses on studying
the role of energy expenditure in the development, mitigation
and monitoring of chronic diseases in children and adults.
Specifically, his team has developed technical tools to measure
physical activity and its associated energy consumption in nonlaboratory conditions.
He hopes that having the ability to assess the energy needs
of patients with chronic illnesses will help improve treatment
options for medical conditions like obesity, sickle cell, sleep
apnea and cirrhosis of the liver.
“Our team has worked to determine the physical activity
habits of lean and obese individuals to learn how these habits relate to the development and propagation of obesity,” said Acra.
“e results of these studies indicate that engaging in
sedentary activities is more of a determinate of overall daily
energy expenditure, more so than the lack of participating in
a vigorous physical activity, an important distinction when
trying to promote a change in daily habits.”
Recently, his team developed a highly effective tool to
measure physical activity and its associated energy consumption under free living or non-laboratory conditions. e result –
a non-invasive, portal device based on accelerometry that can
predict a patient’s energy expenditure with 95 percent to 99
percent accuracy.
e goal is that this tool will enable physicians to detect
changes in a patient’s disease state before the patient is aware
that his or her condition is declining.
“We can use this device to study different diseases in an effort to make a difference in the management and monitoring of
varied health conditions,” said Acra. “A person’s well-being from
– by Jessica Pasley
JoE HoWEll
any chronic disease is affected and/or reflected by activity levels.
“Nowadays, with our rapidly expanding technology, a person will be able to download a profile to a mobile device, which
in turn will have the capability to configure his well-being and
signal that a physician needs to be alerted.”
In the past, health care professionals have relied on patient
input to assist with overall assessments of an individual’s condition. But, as many patients can attest, recall about physical activity or the perception of exertion levels is not always accurate.
Acra, who came to Vanderbilt in 1989, has authored more
than 30 scientific publications including journal abstracts and
book chapters. A summa cum laude graduate of the North
Carolina State University in 1985, he received his medical
degree from the American University of Beirut in 1989 and
his master’s in Public Health from Vanderbilt in 2005. Acra
completed a research fellowship, his pediatric residency and
a clinical fellowship all at Vanderbilt.
DAvID
PArrA, M.D.
Pediatric
Cardiology
•••
David Parra, M.D., knew since he was a young boy growing
up in Quito, Ecuador, that he wanted to be a physician. With no
physicians in his family, he cannot pinpoint what influenced his
interest in medicine. But he believes it was a “calling.”
at calling brought him to Monroe Carell Jr. Children’s
Hospital at Vanderbilt in 2004, just as the new freestanding
Children’s Hospital was set to open. He had been doing his
Pediatric Cardiology Fellowship at the University of Michigan
in Ann Arbor when he received a phone call from omas P.
Graham Jr., M.D., former chief of the Division of Pediatric
Cardiology.
“Dr. Graham wanted to start a cardiac MRI (magnetic
resonance imaging) program at Children’s Hospital,” said Parra,
assistant professor of Pediatrics, whose focus is in pediatric
cardiac imaging. “I loved the group here and the opportunity to
train in cardiac MRI as a faculty member. ere really wasn’t
any cardiac MRI program at the time and we have grown exponentially. My first year, we did maybe 60 patients and now we
do close to 300 patients a year.”
Parra enjoyed the challenges of echocardiography and MRI,
a painless way to take images of the heart to examine structure
and blood flow patterns. He combined that interest with his
passion for helping children, a devotion he honed at Miami
Children’s Hospital during his residency. He earned his medical
degree at the Universidad Central del Ecuador in 1993.
Born in New York City, Parra wanted to return to the
United States to carry out his medical training and became fascinated with cardiac imaging.
“You follow patients, and you see them through their diagnosis, their operation and post-operative recovery. You see
every evolution as you go through these challenges they have,”
said Parra.
In addition to growing the cardiac MRI program at
Children’s Hospital, Parra is also involved in several research
projects, including studying imaging of myocardial function in
heart transplant patients to look for early signs of rejection.
With certain types of contrast dyes, doctors can see scarring, a
sign of rejection, earlier than on more common surveillance
modalities such as an echocardiogram.
He also is involved in a study to use MRI to do T1 mapping
on Duchenne Muscular Dystrophy to detect early cardiomyopathy, heart muscle disease.
Parra, now director of non-invasive imaging for the Division
of Pediatric Cardiology, came to Vanderbilt with his wife, Adriana
Bialostozky, M.D., assistant professor of Pediatrics in the Division
of General Pediatrics at Children’s Hospital. He credits his wife
with helping him study for his exam to become a board-certified
doctor after they met in New York and then moved to Miami
where they did residency together.
Outside the hospital, Parra loves music, taking advantage
of visits from friends and family to listen to live music and all
Music City has to offer. He’s a fan of rock ‘n’ roll, bluegrass and
Americana. Parra also has two sons, Sebastian, 12, and Martin,
10, and travels frequently around the region to watch Sebastian’s
travel soccer team.
–Christina Echegaray
29
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More
GIVING
Celebrating 40 years
of the Music City
Tennis Invitational
IN 1973, HELEN FARMER OF THE AMERICAN CANCER
Society partnered with Wesley Rose, founder of Acuff Rose
Music Publishing, to find a way to raise money for her organization. Rose had the idea that their fundraiser could also be a
way for people in the music industry to network while having
a good time. ey invited top recording artists, songwriters,
musicians and record company executives to participate, and
the Music City Tennis Invitational was born.
In 1977, the tournament directors decided that all of the
funds would go to Vanderbilt Children’s Hospital, now Monroe
Carell Jr. Children’s Hospital at Vanderbilt. is year the
event, a major fundraiser for the hospital, turns 40.
Over the years, much about the tournament has changed.
It has continued to attract top talent in many disciplines, including famed sprinter Wilma Rudolph, tennis player Patrick
McEnroe, singer Kenny Rogers and TV personality Pat Sajak.
ey started holding various auxiliary events to help raise
money, including silent auctions, benefit concerts and in 1995,
the Captain’s Cup, which drew some of the world’s best tennis
DaVID SCHENK oF SCHENK PHoToGraPHy
More than 150 players participated in the 40th anniversary Music City
Tennis Invitational April 20-21, raising $73,000 for the Center for Child
Development at Children’s Hospital.
Go to childrenshospital.vanderbilt.org/giving and find
out how you can make a difference.
players. Patsy Bradley, daughter of the famed record producer,
is co-chair of MCTI and has been involved with the tournament since it began.
To date, the Music City
To date, the Music City
Tennis Invitational has raised
Tennis Invitational has
more than $1.5 million for the
hospital. In 1990, the Center for raised more than $1.5
Child Development at Children’s million for the hospital.
Hospital was chosen as the spe- In 1990, the Center for
cific recipient of funds raised
Child Development at
through the event.
Children’s Hospital
e center’s mission is to
was chosen as the
provide evaluation and treatspecific recipient of
ment to children with a variety
funds raised through
of developmental disabilities.
ese include autism, learning
the event.
disabilities, cerebral palsy and
Down syndrome, to name a few.
e 40th anniversary was celebrated on April 20 - 21 at the
Brownlee O. Currey Jr. Tennis Center at Vanderbilt University.
Country artist Jake Owen served as the spokesperson, while
Nashville television anchor Kelly Sutton was the celebrity
host. To mark four decades of giving, organizers held a party
on the grounds of the Tennis Center, which featured the live
music of James Slater, writer of songs such as Martina
McBride’s “In My Daughter’s Eyes” and Rascal Flatts’ “Unstoppable.” To raise additional funds, Slater also held a showcase at
the Bluebird Café in March, and there was a Pro-Am Tournament before the main tournament along with a live big-ticket
item auction.
e Music City Tennis Invitational has become an integral
part of the Nashville music community’s effort to give back to
the community.
“is is the only
fundraiser benefiting the
Center for Child Development, and it helps us provide
comprehensive care to children and their families,” said
Tyler Reimschisel, M.D., director of the center and assistant professor of Pediatrics at
Vanderbilt. “is care is essential, and the funding we
receive from this tournament
allows us to provide it.”
– by Paula Jones
30
SUMMER 2013
GIVING
rick Dreiling’s lasting impression on Children’s Hospital
SUbMITTED PHoTo
ere is no doubting the
national profile of Monroe
Carell Jr. Children’s Hospital
at Vanderbilt, but at its core
it is deeply tied to the community in which it operates.
Balancing a national profile
and local engagement is no
small task, but as chair of
the Children’s Hospital
Board, Rick Dreiling, chief
executive officer of Dollar
General, has handled it with
great care.
e most visible sign
of Dreiling’s, and the
Board’s, work is the 30,000square-foot expansion in
the Children’s Hospital that
led to the addition of 33
beds for acute, surgical and
neonatal intensive care.
is, along with increased
Rick Dreiling, chief executive
officer of Dollar General,
served as chair of the
Children’s Hospital Board for
two years, leading many important initiatives in that time.
A GROWING PARTNERSHIP
Every year on a spring day in May—rain
or shine—the sounds of pounding hooves
can be heard running at Percy Warner Park
in Nashville. Crowds of up to 25,000 people,
dressed in seersucker suits, fancy dresses
and floppy hats, flock to the premier race of
the year, the Iroquois Steeplechase.
Since 1981, the event has been a key
fundraiser for Monroe Carell Jr. Children’s
Hospital at Vanderbilt, raising more than
$9.5 million over the 32-year partnership.
Ticket sales, along with corporate sponsorships, go toward increasing those funds
every year.
In a show of ongoing support, event
organizers recently decided to specifically
designate the money raised during the
resources for innovative programming, research and
training of future physicians,
was made possible through
the successful completion of
the $33 million Children’s
Health Initiative, which
ultimately raised $2 million
more than its goal.
“e Monroe Carell Jr.
Children’s Hospital
at Vanderbilt provides lifesaving work to the children
of our community. e expansion of the hospital was
an ambitious project to help
ensure we continue to serve
the needs of the children and
families that need us most. I
am very honored to work
with such a dynamic board
that has been instrumental
to making this expansion a
reality,” said Dreiling, who
set the tone among leaders
on the board and in the com-
event and at auxiliary events to the Volunteer State Horsemen’s Foundation Iroquois
Steeplechase Fund at Children’s Hospital—
an endowment that will support critical research addressing childhood diseases or
other pressing needs, as determined by the
chair of Pediatrics.
“Supporting the hospital is something that
everyone in the community can get behind,
because even if you haven’t utilized the hospital yourself, you know someone who has,”
said libby Cheek, executive director of the
event. “Giving back to our children is a very
positive and uplifting experience.”
– by Paula Jones
munity by committing more
than $1 million from Dollar
General to support the
Neonatal Intensive Care
Unit as part of the Children’s
Hospital expansion.
As he prepares to complete his two-year term as
chair, Dreiling’s energy and
enthusiasm will continue to
drive the board’s work to ensure that children and families living in the Nashville
community and those who
come to Children’s Hospital
for care, continue to receive
the highest-quality, compassionate care.
– by Paula Jones
ToMMy laWSoN
Setting the tone
Madeleine "Maddie" Wright, 5, served as child
ambassador for the 2013 Iroquois Steeplechase.
31
LeArn
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DIS C OVE R ING
SUSaN UrMy
Surveillance network tracks shift in cause of
childhood diarrhea
a national vaccine surveillance program that Vanderbilt University
is a part of has identified a significant shift in the most common cause
of childhood diarrhea.
a study released
March 21 in the New
England Journal of
Medicine (NEJM), finds
that norovirus (sometimes
called the Norwalk virus)
is now the leading cause
of childhood diarrhea.
rotavirus once caused 90
percent of cases of childhood diarrhea, but rates have steadily
A national vaccine surdeclined since a vaccine came into
veillance program that
widespread use in 2006.
The New Vaccine Surveillance
Vanderbilt University is a
Network
(NVSN), which includes
part of has identified a
Vanderbilt, the University of rochester
significant shift in the
and Cincinnati Children’s Hospital,
most common cause of
tracks a number of viral illnesses and
childhood diarrhea.
the impact of vaccination.
Kathryn Edwards, M.D., the Sarah
H. Sell and Cornelius Vanderbilt Professor of Pediatrics and director of
the Vanderbilt Vaccine research Program, served as director of the
Vanderbilt arm of the NVSN during this study to examine the causes
of childhood diarrhea from 2008 to 2010.
“It is important to note that even though the threat of rotavirus is
greatly reduced, our study shows the intensity and burden of norovirus
has remained unchanged,” Edwards said.
In the NEJM study, the researchers tracked more than 141,000
children under age 5. Children with diarrhea were treated in hospitals,
emergency departments and outpatient medical offices.
lab testing confirmed the presence of norovirus and rotavirus in
1,295 cases. Norovirus was detected in 21 percent of cases, while rotavirus was identified in only 12 percent.
Understanding bronchiolitis in children
Vanderbilt-led research published in the New England Journal of
Medicine has identified the relatively unknown human metapneumovirus (MPV) as the second most common cause of severe bronchiolitis in young children.
The research spanned six years, from 2003 to 2009, and involved
samples taken from more than 10,000 children under age 5. The children
32
SUMMER 2013
Go to childrenshospital.vanderbilt.org/giving and find
out how you can make a difference.
were hospitalized, treated in an emergency department, or seen in an
outpatient clinic with a lower respiratory infection (bronchiolitis).
“We found MPV is as important a cause of respiratory illness as influenza, and caused more illness than the three common types of parainfluenza virus combined. In fact, in young children, the burden of MPV
was second only to rSV (respiratory syncytial virus) as a cause of bronchiolitis,” said senior author John Williams, M.D., associate professor of
Pediatric Infectious Diseases and a well-known expert in MPV research.
researchers found MPV tends to affect more children over age 1
than rSV, and while both viral infections strike in late winter or spring,
MPV has a seasonal peak that lags behind the typical peak for rSV by
about a month. The authors said physicians commonly see patients
with this virus, but know little about it and are trying to understand
the burden of disease caused by human metapneumovirus.
MPV was first described in 2001 and there are no specific treatments or vaccines for it other than supportive care for bronchiolitis,
such as oxygen, bronchodilators and intravenous fluids.
Partnering to understand sickle cell disease
researchers from the Monroe Carell Jr. Children’s Hospital at
Vanderbilt and aminu Kano Teaching Hospital in Kano, Nigeria, are
collaborating on a study of sickle cell disease treatment for children
in Nigeria.
The National Institutes of Health (NIH) awarded the project a twoyear, $281,490 grant (grant No. 1r21NS080639-01). The funding will be
used to investigate the effectiveness of the drug hydroxyurea as a primary prevention of stroke among children with sickle cell disease, an
inherited blood disorder, in Nigeria. Stroke can be a complication in
patients with sickle cell disease. Hydroxyurea is often given to patients
with sickle cell disease as part of a maintenance protocol to prevent
pain episodes, another complication associated with the disease.
The principal investigators for the study are Michael Debaun,
M.D., MPH, vice chair of Clinical research for Vanderbilt’s Department
of Pediatrics and J.C. Peterson, M.D. Professor of Pediatric Pulmonology;
lori Jordan, M.D., Ph.D., assistant professor in Neurology, and Muktar
aliyu, MbbS, MPH, Dr.PH, assistant professor of Preventive Medicine
in the Vanderbilt Institute for Global Health.
Nigeria has the largest burden of sickle cell disease in the world
with an estimated 150,000 people living with the condition. yet the
most common therapy for the disease, recurrent blood transfusions,
is not readily available. The newly funded trial could help researchers
determine if hydroxyurea would prove to be an alternative treatment
to frequent blood transfusions to prevent the occurrence of stroke in
children at risk. Sickle cell disease is the most common cause of stroke
in children.
– by Christina Echegaray
toys
Cleaning up her to
ys
during
Comforting others dur
ing cchemo
hemo
Not ever
ery
y childhood follows the same script. Grace was 2 when she was diagnosed with acute lymphoblastic
play dates, she also experienced surgeries and chemotherapy.
leukemia. So in addition to birthday parties and play
During her hospital visits, she got to know other children fighting cancer, too. She learned along the way that
IV poles can get out of the way when you want to dance and twirl. As Grace and her family alread
eady
y know, we
Photo by Susan Urmy (Vanderbilt University)
hav
ha
ve everything and ever
ery
yone necessary to be your child’s very own hospital.
Your support is critical to ensuring Monroe Carell Jr. Children’s
Hospital at Vanderbilt continues to offer the highest quality of
care to children and families in our community and beyond.
T
Thank
hank you!
you!
To help even more, you can give now at
ChildrensHospital.Vanderbilt.org/GiveHope
ChildrensHospital.Vanderbilt.org/Gi
ChildrensHospital.V
anderbilt.org/GiveHope
Connect with us
/ChildrensHospital
@VUMCchildren
ChildrensHospital.Vanderbilt.org
Photo by Mandy Johnson courtesy of Flashes of Hope
att babies
Cooing a
Non-Profit Org.
U.S. Postage
Vanderbilt University
Vanderbilt University Medical Center
Office of News and Communications
T-5200 Medical Center North
Nashville, TN 37232
Everybody Has a Story
Everybody Has a Story is a music compilation of heartfelt songs that patients of Monroe
Carell Jr. Children's Hospital at Vanderbilt wrote with the help of a music therapist. The CD,
released worldwide May 14, features some of Nashville’s top recording stars and benefits
the Music Therapy Program. Visit EverybodyHasAStoryCD.com for more information.
PAI D
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Fresh Start - The Monroe Carell Jr. Children`s Hospital at Vanderbilt

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