Dept Annual Report Draft for SVP

2021 EXECUTIVE REPORT FOR DEPARTMENT OF CHRISTINA LUNDQUIST PEDIATRIC NEWBORN MEDICINE every babyTHEBESTFOR

every babyTHEBESTFOR Our mission is to provide the highest quality care to all infants and their families that is compassionate, comprehensive, and skilled; alongside educating for future generations of health professionals, advancing knowledge of newborn science and care, and advocating for optimal health of newborns. Our vision is to be the regional and national leader in discovery and application of skilled and compassionate newborn and family care. Parents want the best for their baby, both before and after birth. Our goal is for every baby to receive the best possible newborn care and every family to be fully informed, engaged, and involved in their baby's care right from the very beginning.

We lead the field in... Clinical care - Our department leads the field in newborn medicine, with particular expertise in achieving better outcomes for premature and seriously ill babies. Teaching - As the teaching hospital of Harvard Medical School and a residency and fellowship site for Mass General Hospital and Boston Children's Hospital, we train the next generation of neonatal practitioners. Research - Our nationally and internationally recognized clinicians are leaders in neonatal research; their clinical and lab-based studies expand what is possible for the babies we serve and infants across the globe. 7,200+ And hosted 20 Births 350+ Active research studies In 2021 we estimated Physicians in training

innovationA LEADER IN Music Therapy in This initiative is a partnership between BWH and Roman the GDU Music Therapy Services, and will introduce clinical music therapy services to infants and their families in the Director: Dr. Carmina Erdei Growth & Development Unit (GDU). The program will also support families and staff by providing education Social Media related to music exposure and music therapy interventions within the family-centered developmental Director: Dr. Tanzeema Hossain care model. This program will enhance age- and @brighamNICU developmental stage-appropriate stimulation, support the progression of developmental skills, provide pacification support, and strengthen the parent-infant communication relationship. The education team develops the department's social media strategy. The goal is to highlight major research publications, staff/faculty awards, and relevant current events to grow our professional and community-based following. Currently, the group is focused on using both Instagram and Twitter platforms.

communityA LEADER IN DE&I Task Force The Department of Pediatric Newborn Medicine is committed to opposing discrimination in all forms. Directors: Drs. Silvia Patrizi, Currently, the Diversity, Equity & Inclusion (DEI) Task Tanzeema Hossain and Carmen Force is focused on antiracism, yet strives to promote Monthe-Dreze inclusiveness and expression of each individual's beliefs and dialogues. The task force works to implement Transition to Home strategies to dismantle racial inequalities in the health outcomes of newborns and their families, to create and Director: Dr. Mollie Warren celebrate a diverse and inclusive environment for patients and all members of the department, and work Bridges to Moms to restore trust among underrepresented minorities through acknowledgement and repair. Director: Dr. Roseanna Means This new program aims to reduce NICU length of stay by 5-8 days and provide virtual care between physicians and parents to monitor the child's growth and feeding development. The hope is to give parents more autonomy and agency in their child's care, by inputting data metrics, as well as keeping up with NICU demand. The Transition to Home program will utilize an iPad loaner system to ensure that all families have equitable access to the technology needed to participate in the program. The Bridges to Moms initiative uses intensive case management support to connect women affected by housing insecurity to community based resources in order to establish a safe network of transportation, baby supplies, food, etc. The group meets with moms during the prenatal, peripartum, and postpartum period to evaluate both their health needs and barriers that may affect a mother's nurturing relationship with her child.

qualityA LEADER IN NeoQIC Family This initiative is focused on improving adherence to Engagement evidence-based family engagement practices and reducing disparities by race/ethnicity and language Director: Dr. Maggie Everett status that occur at Level 2 Special care Nurseries and Level 3 Neonatal Intensive Care Units statewide. The Neuroprotection of group is working to identify root causes of Premature Infants dissatisfaction and identify areas for improvement. They are working to target initial family meetings and Director: Dr. Mohamed El-Dib daily rounds in collaboration with local network hospitals. Parent Mental Health Infants born prematurely at 23-27 weeks gestational age are at a higher risk of developing intraventricular Director: Dr. Cindy Liu hemorrhage (IVH). IVH decreases the survival rates of premature infants while those who do survive are at risk for significant developmental complications. Due to above average rates of IVH in the BWH NICU, this project is focused on identifying factors contributing to the development of IVH in our NICU environment. Our group aims to reduce the mean rate of any grade IVH by 20% within a 6-month period by participating in the Clinical Process Improvement Leadership Program (CPIP). With approximately 40% of NICU parents screening for depression, mental health is an important component to measure the success of the department. The goal of this subgroup is to serve NICU parents and provide them with health screening assessments and services for the duration of their child's stay. The team consists of a social worker, psychiatrist, and a psychologist with services primarily being delivered by the psychiatric social worker. Ultimately, the hope is to be able to coordinate referrals to community resources upon a child's discharge from the NICU.

high risk infantsEXPERTCAREFOR With 66 beds, the Brigham and Our NICU team is highly collaborative Women's Hospital Neonatal and multidisciplinary. In addition to Intensive Care Unit (NICU) is the your medical team, your baby is largest in Massachusetts. We are supported by a team of allied health well prepared to provide the best professionals to ensure the highest and most advanced care possible to quality of care. Specialty care teams newborns with critical and unique are designed to meet a baby's health challenges. Our Level III individual needs and regularly consult facility cares for over 3,000 babies with families. annually. Newton Wellesley Hospital's Special Care Nursery (SCN) The SCN at Newton-Wellesley Hospital provides 24-hour newborn specialist care to babies born prematurely or with certain medical conditions beyond what can be provided at a mother's bedside. The SCN is made up of 12 baby care areas that are private and spacious, taking into consideration the comfort and bonding needs of babies and families.

THE BEST AT Well Baby Nursery Happily, most babies born at BWH are As an academic medical center, we are healthy! Our faculty and staff are passionate proud of our record in excellence and about supporting parents and their loved collaboration in clinical care, teaching, and ones during those magical and sometimes research. As such, our pediatricians help stressful first days of parenting. We are develop and implement the clinical practice committed to providing the best care for guidelines that ensure evidence-based, babies, taking into account that the needs consistent, medical practice at BWH. and preferences of each family are unique Additionally, our pediatricians are teachers, and important. To provide the best care, it as well as clinicians, and are joined by requires a team of clinicians that are students and trainees from Harvard medical dedicated to understanding your baby and School and the Boston Combined Residency family's needs. In addition to routine care, Program in Pediatrics to care for well the BWH Faculty Newborn Service is also newborns and their families. Finally, as a able to provide a number of supplemental premier research institution, BWH offers services including lactation consultation and interested families the option to participate expertise in newborn behavior and in a variety of research studies. development.

every stage Center for Child Development The Center for Child Development (CCD) is a NICU Follow-up Program: We state-of-the-art facility housing the typically see infants two to four weeks department's outpatient programs. This post-hospital discharge until the 1,889 square foot space is home to four transition to pre-school around age clinical rooms in addition to designated three. Through a multidisciplinary research space. Since opening its doors in approach, the program supports November of 2017, the CCD has performed infants with a range of medical and 5,279 clinical and research encounters. developmental conditions. The CCD provides support for patients and families through a number of programs 190% including: the NICU follow-up program, feeding and nutrition program, lactation 72.7% Increase in consulting, and the Transition to Home Converted Referrals Program. In the coming months, the CCD will from FY20 to FY21 also launch a school-aged program to follow patients who continue to require services Patient Satisfaction after they graduate from the NICU follow-up Score program at age three. 100% Referral Conversion Rate

AmDVANuCINlGtidisciplinary Nursing The NICU nurses practice family-centered care and strongly encourage parents to participate in the care of their infant, through skin-to-skin contact, safe handling and kangaroo care. Their goal is for every baby to receive the best possible newborn care and for every family to be equally well cared for—to be fully informed, engaged, and integrated in their baby’s care, from the very beginning. Allied Health We offer occupational therapy (OT), physical therapy (PT) and speech and language pathology (SLP) services that teach therapeutic interventions, activities and handling strategies in order to achieve developmental milestones. A registered dietitian/nutritionist makes rounds with the medical teams on a daily basis to design and oversee nutrition plans for each baby. These plans may include intravenous (IV) nutrition, breast milk, and/or formula. Our NICU respiratory therapists manage, in collaboration with the NICU medical team, any infant who is on high-flow nasal cannula or mechanical ventilation (invasive or non-invasive), careincluding conventional and high-frequency ventilation.

EXPANDING ACCESS TO BASIC CARE Global Health Dr. Anne (CC) Lee, Director of The Brigham With continued support from the Gates Global Newborn Health Lab, conducts research foundation, the Global AIM team and partners focused on clinical interventions to improve at Addis Continental Institute of Public Health the health of mothers and babies in under- have also established a biobank of specimens resourced global settings. Dr. Lee and the AIM for future studies of metabolomics, Lab initiated the ENAT (Enhancing Nutrition proteomics, microbiome and other discovery and Antenatal Infection Treatment) study in analysis. Another landmark in 2021 is the the West Gojjam and South Gondar Zones of establishment of a infant follow up program. Amhara regional state, Ethiopia. This project is In a collaboration of global experts in neuro- a pragmatic randomized clinical effectiveness development and neuroimaging, ENAT will be study that aims to test the impact of antenatal receiving one of the first low-field, portable interventions to optimize maternal nutritional magnetic resonance imaging devices. A status and infection management in Hyperfine MRI machine will arrive in the ENAT pregnancy, on maternal and infant health field site in the fall 2021, providing both outcomes. This study, funded by the Bill and research and clinical services. This machine Melinda Gates Foundation, will enroll over will not only provide a unique opportunity to 2000 pregnant women and infants. Despite implement an MRI system in a rural field challenges including COVID-19, civil unrest research setting, but will be used to explore and severe flooding the team has enrolled early infant MRI outcomes associated with 2000 women in the first year of the study. prenatal interventions.

researchA LEADER IN NEONATAL In 2021 we received The Department of Pediatric Newborn Medicine has a robust research program that focuses on both clinical 4 and translational research as well as basic science investigation. Research initiatives are led by the New Active Funded Research Executive Committee (REC), a multidisciplinary Studies group of leaders responsible for the productivity, allocation of research resources, and quality of $2.5M research done within the department. The department also has a Clinical Studies Coordination Team, led by In New Support * the director of research, and consists of research nurses, coordinators, and assistants. Currently, we *impacted by COVID-19 Pandemic support 17 investigators working on 20 active clinical studies mostly based in our neonatal intensive care 4:1 unit, but also including our well babies and work around the world. Thus far in 2021, researchers within Return on the department have submitted 50 proposals valued Sponsor at 65 million dollars. Investment Areas of Focus Supporters Neonatal cardiovascular, pulmonary, and National Institutes of Health (NICHD, NHLBI, integrated biology NIGMS, NINR, NIMH) Pediatric, newborn, and fetal Bill & Melinda Gates Foundation developmental neuroscience Gerber Foundation Global advancement of infants and American Academy of Pediatrics (AAP) mothers (AIM) CRICO/Research Management Foundation Newborn genomic medicine US Health Resources & Services Nutrition for mothers and infants Administration Industry Partners

Highlighted Active Research Protocols Baby AMOR Study - Dr. Lise Johnson developed a randomized controlled trial (RCT) of a Newborn Behavior Observation (NBO)-based intervention to improve the health and well-being of moderately and late preterm infants and their mothers. Bose Study - Drs. Carmina Erdei and Terrie Inder aim to evaluate the feasibility of a music-based program in the NICU, and to assess any neurophysiological and behavioral effects in preterm infants receiving the intervention. Lifestyle Intervention in Preparation for Pregnancy (LIPP) Study - Dr. Rimi Sen developed a randomized, controlled trial of a lifestyle intervention (moderate calorie restriction with shift to a Mediterranean diet and regular exercise) in post-partum women with overweight or obesity who are planning a subsequent pregnancy in the next 12-24 months. Nourish Study - Dr. Mandy Belfort developed a randomized, controlled clinical trial of individually targeted fortification for human milk-fed preterm infants during NICU hospitalization. Screened But Not-Cooled Study - Drs. Terrie Inder and Mohamed El-Dib seek to investigate the short-term outcomes among a cohort of infants that were screened for Therapeutic Hypothermia (TH) but ultimately did not receive treatment. Transcutaneous Carbon Dioxide Monitoring in Neonates Receiving Therapeutic Hypothermia for Neonatal Encephalopathy (TCOM in HIE) Study - Drs. Mohamed El-Dib, Terrie Inder, Helen Christou, Maria Franceschini, Eniko Szakmar and Jill Robinson, RRT aim to understand how low pCO2 has been associated with worse neurodevelopmental outcome in those receiving therapeutic hypothermia for & innovationneonatalencephalopathy.

educationA LEADER IN PEDIATRIC 196 Consulting Residents & Fellows Educational programming targets many 141 facets of the department and includes trainee education programs, faculty Rotating Interns development and education, wellness and and Residents resiliency programming, teaching awards, presentations, and publications, and also 25 includes program feedback and social media strategy. The overarching goal is to provide continuing education to staff and trainees (including medical students). We Train the Best Rotating Fellows 18 PRIMARY TRAINING SITE FOR: Summer Students Boston Combined Residency Program in Pediatrics and Interns Mass General Hospital Pediatric Residency Program Harvard Fellowship Program in Neonatal-Perinatal Medicine

knowledge & careADVANCING Meetings & Conferences NICU Operations NICU Case Discussion NICU M&M Faculty Meeting Faculty Education Seminars Pediatric Newborn Medicine Clinical Practice Council Newborn Brain Society Webinar Series Rounds Pediatric Grand Rounds Neuroradiology Rounds Perinatal Rounds Other Event Offerings Inaugural Simulation Session with Baby Paul Summer Student Research Program March of Dimes

WHAT MAKES US THE BEST Our People Brigham and Women's Hospital Department of Pediatric Newborn Medicine Faculty Leadership Team Terrie Inder, MBChB, MD Helen Christou, MD Elizabeth Flanigan, MD, MPH Department Chair Executive Vice Chair for Research, Chief of Clinical Operations Education & Faculty Academic Affairs Margaret Everett, MD Simon Manning, MD Sujatha Ramadurai, MBBS Katharine Herrick, MD NICU Associate Medical NICU Associate Medical Director of Special Care Nursery, Medical Director of Well Director Director Newton-Wellesley Hospital Newborn Care Director of Fetal Care Mandy Belfort Brown, Jennifer Benjamin, MD Sule Cataltepe, MD Megan Connelly, MD MD, MPH Director of NICU Follow-Up Medical Director of Newborn Associate Medical Director of Director of Clinical Research Program Respiratory Care Well Newborn Care

Mohamed El-Dib, MD, FAAP Carmina Erdei, MD Tanzeema Hossain, MBBS Lise Johnson, MD Director of Neonatal Director of the Growth & Director of Education Co-Director of the Brazelton Neurocritical Care Development Unit Institute Anne (CC) Lee, MD, MPH Cindy H. Liu, Ph.D Carmen Monthe-Dreze, MD Richard Parad, MD, MPH Director of Global Health Director of Developmental Director of Physician Well- Director of Newborn Risk & Cultural Disparities Being Medicine Genomic Program Program & Physician Credentialing Silvia Patrizi, MD Rimi Sen, MD Mollie Warren, MD Director of Diversity, Equity & Director of Faculty Director of Transition to Home Inclusion Development Program Neonatologists Katherine Bell, MD Laura Bernardini, MD Donna Brezinski, MD Saila Ghanta, MD

Terri Gorman, MD Elisabeth Kaza, MD, DSc Stella Kourembanas, MD Amy Levingston, MD Chief of Newborn Services, Boston Children's Hospital Nisreen Maari, MD Alyssa Marshall, DO Krysten North, MD, MPH E. Annette Scheid, MD Fotios Spyropoulos, MD Melissa Woythaler, DO Pediatricians Jo Ellen Altschaefl, MD Susan Beebe, MD Anna Cooley, MD Amanda Gallant, MD

Timothy Porter, MD Carolyn Rundquist, MD Erica Swartz, MD Ann Velie, MD Advanced Practice Providers Corey Boyd, RNC, MSN, Deb Giambanco, NNP Adrianne Louloudes, PNP Deb Marks, PNP NNP-BC Well-Baby Nursery NICU NICU NICU Rachael McClure, PA Kathleen Murphy, DNP Susan Quinn, MS, ARNP, Katrina Miller, PNP NICU NNP-BC NICU NICU NICU Research Faculty Sara Cherkerzian, SM, ScD Pamela Dodrill, PhD, Mark Perrella, MD Joseph Volpe, MD CCC-SLP

BRIGHAMANDWOMENS.ORG/PEDIATRIC-NEWBORN-MEDICINE We innovate, investigate, and collaborate to provide the best care for every baby.