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Home Explore Dept Annual Report Draft (1)

Dept Annual Report Draft (1)

Published by BWH Pediatrics, 2021-11-29 19:05:43

Description: Dept Annual Report Draft (1)


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leads the worldBRIGHAM AND WOMEN'S HOSPITAL IN EXPERT FAMILY-CENTERED NEWBORN MEDICINE Dear Colleagues and Friends, Sincerely, Dr. Terrie Inder, MBChB, MD Mary Ellen Avery Professor of Pediatrics, Field of Newborn Medicine, Harvard Medical School Chair, Department of Pediatric Newborn Medicine, Brigham and Women's Hospital

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. 6,690 And hosted 80 Births 350+ Active research studies In 2021 we facilitated Physicians in training

Financials 52.5 Average Daily Census Despite the COVID-19 pandemic, the Department of Pediatric Newborn Medicine continued to experience growth in FY 2021. This included a 19% increase in charge volume department wide in addition to a 13% increase in receipts. The graph below outlines the Annual Budget and the breakdown of the department's expenses over FY 2021.

Department Makeup 7 Awards and Honors New Physicians These awards recognize faculty for achievements in one or more of the 5 pillars 6 of academic medicine: Education – Honored nominations Drs Hossain Leadership and Bell Promotions Research – Honored nomination Dr Belfort Community Service – Pillar Award Dr Lee 31 Diversity & Inclusion – Pillar Award Dr Patrizi Neonatology Dr. Altschaefl named BWH Outstanding 26% Faculty Clinician purely clinicians 50% are Pamela Dodrill Recipient of the Diana Bracco moonlighters Outstanding BCS-S Applicant Award 10% Dr. Carmen Monthe-Dreze Recipient of the Harvard Medical 45% are School Diversity Inclusion, and Community Partnership are researchers Faculty Fellowship and for being named a formal mentr as researchers part of the Boston Combined Residency program's Mentor MED Mentorship Program 52% hold Dr. Fotios Spyropolous Recipient of the American College of leadership Cardiology Young Investigator Award titles Drs. Elizabeth Flanigan and JoEllen Altschaefl on receiving the 2021 Brigham Health Distinguished Clinician Award Dr. Simon Manning Recipient of the BWPO Professionalism Award 20 Carrie Dodge, RRT Recipient of the 2021 PHIL Award Pediatrics Marissa Hayes recipient of the DAISY award Faculty Yamiley Cayemnitte recipient of the Essence of Nursing Award 35% hold leadership titles

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 aims to enhance age- and @brighamNICU developmental stage-appropriate stimulation, support the progression of developmental skills, provide pacification support, and strengthen the parent-infant relationship within a family centered care framework. 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 improve Director: Dr. Mollie Warren the recruitment, retention and promotion of Underrepresented in Medicine, to create and celebrate Bridges to Moms a diverse and inclusive environment for patients and all members of the department, and work to restore trust Director: Dr. Roseanna Means among underrepresented minorities through acknowledgement and repair. 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 and provides families support to ensure a smooth transition from the hospital setting to the home environment by connecting families with medical providers who know their infant(s) well from their NICU stay. 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. Additionally, families can reach out for quick access during business hours via a pager. 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 among families and identify areas for improvement. They are working to target initial family Director: Dr. Mohamed El-Dib meetings and 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 program is to serve NICU parents and provide them with health screening assessments and psychotherapy for the duration of their child's stay. The team consists of a social worker, psychiatrist, and a psychologist with services 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. Many of our faculty at BWH also staff the Newton Wellesley Hospital SCN.

Far From Home Miles, 2 weeks Miles, 3 weeks “I’m sure it’s nothing, likely a false alarm. Should I get checked Miles, 1 month out immediately here in Boston or get back home [to California] to see my doctor tomorrow?” These were the thoughts flooding Azita Habibi’s mind on July 8th, 2021 as she began to experience odd symptoms at 32 weeks pregnant while visiting Cape Cod. Azita and her husband were preparing to return home to California later that evening. Finally, at the recommendation of a dear OBGYN friend, Azita decided to head to Brigham and Women’s Hospital that evening, rather than taking the cross-country flight back to San Francisco. After being admitted at BWH, the providers in Labor & Delivery discovered that Azita had some bleeding in her uterus, causing the atypical symptoms she had felt earlier. Azita understood that in the best-case scenario she would be on bedrest for two weeks and deliver at 34 weeks gestational age. This was the first of many shockwaves to hit her system. “Two weeks in a hospital in Boston thousands of miles away from home? I’m going to deliver my baby at 34 weeks? Isn’t that TOO early?” she worried. As Azita tried to settle into sleep in her hospital room, around 3 AM that night she felt a huge rush of water between her legs and began to feel contractions, increasing in intensity, and realized that her baby was not waiting until 34 weeks… From the moment she walked into Neighborhood 1, there was no lack of information, transparency, and empathy from the entire staff at Brigham... It was all so new and unfamiliar and yet the staff were patient, generous with their time, and genuine in their care. The next thing Azita knew she was in Labor & Delivery again, except this time, she was being administered an epidural and several doctors were explaining what would happen to her over the next 24 hours - what to expect in the NICU and beyond at BWH. It was a blur, but she remembers feeling like she was in several very capable hands, all of whom were compassionate for the shock and trauma she was experiencing. About 5 hours later, Azita delivered her first child weighing 3 lb 14 oz and measuring 17 in. After seconds of skin-on-skin contact, her fragile baby boy was whisked away to the NICU as she was treated in post-partum.

As soon as she could, Azita went up to the NICU where her They were fortunate that Miles developed and baby was in an isolette, wires and tubes hooked up and gained weight in line with his gestational age and several doctors and nurses waiting for her arrival. From the were discharged just days before his due date of moment she walked into Neighborhood 1, there was no Sept 2nd, 2021. After discharge, Azita and her lack of information, transparency, and empathy from the husband remained in Boston for another three entire staff at Brigham. They were welcoming and weeks to complete Miles’s two-month encouraging of Azita and her husband asking any question, immunizations and ensure was adjusting well to participating in morning rounds, and taking part in their life outside of the NICU. After returning home in baby’s care. It was all so new and unfamiliar and yet the Oakland, CA, where they were finally able to settle staff were patient, generous with their time, and genuine in into a new more permanent rhythm, Miles their care. flourished. “He’s delighting us with his smiles and animated babbles. He’s a master of tummy time, Azita learned that while 32 weeks had “I have which I attribute to his head start in the NICU with seemed incredibly early to her, it was boundless the PT, Jess. We know that Miles is thriving now considered moderate prematurity gratitude for because of his impeccable care at Brigham for the with extremely high odds of survival first 8 weeks of his life. While this unexpected preterm birth was nothing short of an ordeal for and “normal” developmental those nurses. my husband and I, the silver lining of this entire outcomes in the NICU. The first ten Knowledgeable, experience was that it happened at the Brigham days were very difficult, watching her NICU. I have no doubt in my mind that he received the absolute BEST care in the world at Brigham, fragile baby begin his life wrapped in fearless, and and for that, I am forever indebted.” wires, under phototherapy lights, and nurturing, these connected to a c-pap device necessary nurses continue to breathe properly. “Babies are resilient,” said everyone around her. to inspire me. We could not During their first 48 hours Azita and her have made it husband needed to declare a name for through those Miles & Mom Azita, 3 months their baby. After much deliberation they two months agreed on the name of Miles, given that he was born miles and miles away from without the home. The chair of the NICU, Dr. Terrie tireless, Inder, stopped by after hearing Azita’s extraordinary crazy story and “was as impressively brilliant as she was empathetic and NICU nurses at warm, and helped to put [their] anxious the Brigham.” minds at ease. She generously gave [the Habibis] a book titled “The Early bird,” a touching story about a premature pukeko bird, warming [their] tender Miles with Mom & Dad hearts.” 8 weeks Over the next 7 weeks, Azita and her husband watched Miles develop and grow outside of the womb and quickly picked up on the NICU norms. Despite being fish out of water, they developed a rhythm in the Brigham NICU, facilitated by “the amazing NICU nurses.” Miles (and Mom) quickly developed bonds with his primary nurses, aka his angels - Alli, Ciara, Linda, and the many other extraordinary nurses who cared for him. “I have boundless gratitude for those nurses. Knowledgeable, fearless, and nurturing, THE STORY OFthese nurses continue to inspire me. We could not have made it through those two months without the tireless, extraordinary NICU Miles Habibi HarrisnursesattheBrigham.”

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. The newborn hospitalists: • performed 15,452 newborn visits in FY 21 • performed 1,315 procedures: 1,276 circumcision, 101 frenotomies • trained 18 interns and 54 HMS students

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 houses several transition to pre-school around age outpatient and research initiatives. Since three. Through a multidisciplinary opening its doors in November of 2017, the approach, the program supports CCD has performed 5,279 clinical and infants with a range of medical and research encounters. The CCD provides developmental conditions. support for patients and families through a number of programs including: the NICU 83.7% 190% follow-up program, feeding and nutrition program, lactation consulting, and the Net Promotor Increase in Transition to Home Program. In the coming Score Converted Referrals months, the CCD will also launch a school- from FY20 to FY21 aged program to follow patients who continue to require services after they 100% graduate from the NICU follow-up program at age three. Referral Conversion Rate

From NICU... To Follow-Up... And Beyond...

AmDVANuCINlGtidisciplinary Nursing The NICU nurses practice family-centered care and strongly encourage parents to participate in ensuring the well-being 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 nurtured—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 are highly trained in Neonatal Respiratory Care and are an integral part of your baby’s care team. The NICU RTs provide and manage support for your baby’s respiratory needs starting in the delivery room and through out your baby’s stay in the NICU. Different types of respiratory support that your baby may utilize include oxygen delivery devices, CPAP, mechanical ventilation, high frequency ventilation, and nitric oxide. The NICU RT staff are also responsible for maintaining and running the Blood Gas Lab here in the Neonatal ICU. care

Speech and Language Pathology The SLP team works collaboratively with medical and nursing providers to support the care of infants during their stay at BWH. Some examples of feeding and swallowing developmental support include diagnosing sucking and swallowing disorders to determine abnormal anatomy and/or physiology associated with these disorders, performing instrumental swallowing assessments to evaluate swallowing function and determine aspiration risk, and helping to establish early feeding patterns that support optimal feeding, nutrition, and interaction patterns throughout childhood. The speech and language pathology team who works at the BWH NICU is an accomplished group of individuals who routinely work to provide the best care to infants. Some of the NICU feeding team’s accomplishments this year are listed below. The team participated in a review of NICU feeding Clinical Practice Guidelines which informs feeding practices throughout the NICU and can affect patient safety, contribute to delays in achieving early feeding milestones, prolong length of stay, and potentially contribute to long-term feeding difficulties. The team is about to commence performing video-fluoroscopic swallow studies (VFSS) with BWH Radiology. VFSS is a radiographic procedure which provides a dynamic view of the feeding mechanism during swallowing. This procedure is considered the “gold standard” for detecting laryngeal penetration and aspiration during swallowing. Pamela Dodrill, PhD, CCC-SLP, BCS-S participated in an international expert committee to develop consensus definition for Pediatric Feeding Disorder (PFD) which was published. Respiratory Therapy Our NICU RTs are highly trained in Neonatal Respiratory Care and are an integral part of your baby’s care team. The NICU RTs provide and manage support for your baby’s respiratory needs starting in the delivery room and through out your baby’s stay in the NICU. They they respond to all high-risk deliveries including those of infants born before 32 weeks gestation, infants with serious congenital defects, or infants who need respiratory assistance upon delivery. All of our NICU therapists are certified registered respiratory therapists (RRT) and some also are credentialed as neonatal pediatric specialists (NPS). Different types of respiratory support that your baby may utilize include oxygen delivery devices, CPAP, mechanical ventilation, high frequency ventilation, and nitric oxide. The NICU RT staff are also responsible for maintaining and running the Blood Gas Lab here in the Neonatal ICU which facilitates optimal and timely management of infants requiring respiratory support..

NICU Developmental Team Occupational Therapy Our Occupational Therapy clinical specialist (OT) Jessica Pacheco, MOT, OTR/L, CNT, provides services both in the NICU and the NICU Follow-Up program. She’s specially trained to help premature and medically complex babies participate in their “occupations.” Historically, NICUs have focused on the medical aspects of fragile infant care. More recently, the Brigham NICU team has evolved to make sure these vulnerable patients and their families are set up for long- term success with high-quality, expert neurodevelopmental care, including the occupational therapy that Jessica provides. See what our OT has to say about her work: For families involved, it is often a traumatic, life-altering event, and we do our best as a team to help support an infant’s neurodevelopmental progression along the baby’s journey. “The infants and families can really integrate all of the knowledge they’ve learned in the NICU environment, take it home with them to carry on with their infant’s developmental progression, and then come to the Follow-Up Clinic for additional guidance,” she explains. “We meet the infants and caregivers where they’re at, and then take next steps to create goals to set them up for success once they leave the walls of the NICU and head into the community.” Physical Therapy Developmental therapists in the NICU consist of physical and occupational therapists. They work with families to help infants develop age-appropriate skills and provide infants and families with the best resources to achieve motor milestones. Developmental therapists support families and help families understand, bond, care for, and interact with their infants. Developmental therapists can help families: Recognize “ready to interact”/engagement and stress/disengagement cues Understand movement and development Perform age-appropriate activities with infants Help learn what infants can hear, taste, smell, see, and feel Explain ways to comfort infants Promote bonding between families and infants Describe and show families how to touch, hold, handle, and care for infants in safe and supportive ways Recommend therapy resources post-discharge

Social Work The Care Continuum Team in the NICU consist of social workers, case manger’s, and family support specialists. The clinical team practices in collaboration with the health care team promoting health and equity along with safe discharges into the community. Social workers are the leaders in making sure our families get the help they need including food, resources, and baby essentials along with providing emotional support during a NICU admission . Our social work team consists of skilled clinicians who all specialize in caring for to ensure we can meet the family where they are at. Our multiples social worker begins working with families of multiples and begins the process of preparing for twins or triplets. We have a fetal care social worker partner’s with Children’s hospital to ensure the babies who have abnormalities receive support and facilitate between the two institutions. Our medical social workers who are embedded in the NICU empower families and promote positive outcomes for babies through advocacy, support, and Our family support specialists, even though the restrictions of covid, held lasting memories with mother’s day sweet treat and father’s day activities. Made over 3,000 footprint necklaces This year we supported: 29 car seat and stroller combo for families Provided over 10,000 dollars in gas cards Offered over 100 meals for breastfeeding mothers Nutrition Services The Neonatal Nutrition Team, comprised of Registered Dietitian-Nutritionists (RDNs), continues to participate in daily rounds to assist the medical team in the management of enteral and parenteral nutrition support, as well as growth monitoring and assessment of Brigham and Women’s tiniest patients. Our team expanded in 2020 to include more time in the Center for Child Development clinic, the newly created Feeding and Nutrition (FaN) clinic, and the upcoming Transition to Home Program, in order to provide for more continuity of care through discharge home and beyond. The RDNs also participate in the education of the trainees in an ongoing basis and play an active role in the NOURISH study protocol, assisting with consent and study protocol calculations and upkeep. The Neonatal Nutrition Team continues to be involved in policy and clinical practice guideline development. In addition, quality improvement data collection is ongoing by the RDNs, with plans to regularly review and share key Nutrition and Growth related benchmarks with our entire NICU staff. From birth, through discharge and beyond, the Neonatal Nutrition team strives to provide up-to-date, evidenced-based best practice for our patients, while also contributing to the overall body of knowledge of Neonatal Nutrition science.


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 16 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 $2.9M 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 22 investigators overseeing 80 active studies. This includes 16 active clinical studies plus at least 7 5:1 more planned to commence in 2022. The majority of clinical studies are based in our neonatal intensive care Return on unit, but also include well baby studies and our global Sponsor newborn health program. Thus far in 2021, researchers Investment within the department have submitted 53 new proposals valued at 69 million dollars. 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 neonatal encephalopathy. & innovation

Highlighted COVID Research Study (Cindy Liu) The Perinatal Experience and Related Publications: COVID-19 Effects (PEACE) COVID-19-related health worries compound the study is a nationwide longitudinal study psychiatric distress experienced by families of high- which began in May 2020. The purpose of risk infants. Liu CH, Mittal L, Erdei C. J Perinatol. 2021 05; 41(5):1191-1195. PMID: 33658613. this work is to understand the psychosocial effects of COVID-19 on women during the Risk Factors for depression, anxiety, and PTSD perinatal period (pregnancy and symptoms in perinatal women during the COVID-19 postpartum). Through our online surveys, pandemic. Liu C, Erdei C, Mittal L. Psychiatry Research. we have learned about the experiences of 2020 Nov 4:113552. doi: 10.1016/j.psychres.2020.113552. Epub ahead of print. PMID: 33229122. stress, well-being, and resilience among Psychological risks to mother-infant bonding during mothers and their infants during this the COVID-19 pandemic. Liu CH, Hyun S, Mittal L, Erdei C. unprecedented time. To date, we have Pediatr Res. 2021 Oct 14. PMID: 34645943. enrolled over 2000 women and are now in Wave 2 of our data collection. Our work has uncovered how grief related to the pandemic is linked to maternal mental health and bonding, and the how health worries about COVID-19 exacerbates the mental health concerns particularly among NICU parents. By conducting and analyzing behaviors from recorded Zoom-based interaction sessions, we are now working to understand how the responses to the pandemic in the first year might have an impact on the mother-infant relationship and infant response to stress. With additional funding, we plan to implement a Wave 3 data collection to follow children in toddlerhood. To date, we have published 8 papers from this project, with this work featured in major news outlets including US News and CBS Boston. More information about our work can be found at

Highlighted Publications Optimizing initial neonatal resuscitation to reduce neonatal Aging at the beginning of life: a longitudinal Challenges in respiratory encephalopathy around the world. study of telomere length in hospitalized management during therapeutic Patterson J, North K, Dempsey E, very preterm infants. Belfort MB, Qureshi F, hypothermia for neonatal Ishoso D, Trevisanuto D, Lee AC, Litt J, Bosquet Enlow M, De Vivo I, Gregory K, encephalopathy. El-Dib M, Szakmar E, Kamath-Rayne BD. Semin Fetal Tiemeier H. PLoS One. 2021 Jan; 16(1): Chakkarapani E, Aly H. Semin Fetal Neonatal Med. 2021 Jun 22; 101262. e0243468. Neonatal Med. 2021 Jun 19; 101263. PMID: 34193380. PMID: 34244080. Fatty Acid-binding Protein 4 Expression in The roles of life stress and Tumor Cells as a Potential Marker for Induction of Sepsis Via Fibrin Clot preventive health behaviors on Anaplastic Meningiomas. Lee V, Smith TW, Implantation. Ghanta S, Kwon MY, parent mental health during the Arikan MÇ, Zhang L, Çataltepe O, Çataltepe S. Perrella MA. Methods Mol Biol. 2021; COVID-19 pandemic. Liu CH, Smiley Appl Immunohistochem Mol Morphol. 2021 2321:17-25. PMID: 34048004. PA, Vicman JM, Wong GTF, Doan SN. J Feb 1;29(2):e10-e16. doi: Health Psychol. 2021 Jun 29; 10.1097/PAI.0000000000000848. Patient characteristics associated 13591053211026742. PMID: 34187219. with SARS-CoV-2 infection in Clinical Characteristics and Breastfeeding parturients admitted for labor and Effect of Omega-3 Supplementation Outcomes in Term Dyads Following In- delivery in Massachusetts during in Pregnant Women with Obesity on Hospital Supplementation with Pasteurized the Spring 2020 surge: A prospective Newborn Body Composition, Growth Donor Human Milk or Formula. Riley J, cohort study. Reale SC, Lumbreras- and Length of Gestation: A Cherkerzian S, Benjamin C, Belfort MB, Sen S, Marquez MI, King CH, Burns SL, Fields Randomized Controlled Pilot Study. Drouin K, Gregory K. Breastfeed Med. 2021 09; KG, Diouf K, Godlfarb IT, Ciaranello AL, Monthé-Drèze C, Sen S, Hauguel-de 16(9):717-724. PMID: 33872065. Robinson JN, Gregory KE, Grad YH, Mouzon S, Catalano PM. Nutrients. Huybrechts KF, Bateman BT. Paediatric 2021; 13(2):578. Targeting human milk fortification to and Perinatal Epidemiology, DOI: improve very preterm infant growth and 10.1111/ppe.12743 Differences in clinical and brain development: study protocol for laboratory biomarkers for short and Nourish, a single-center randomized, Neuroimaging of the Preterm Brain: long-term respiratory outcomes in controlled clinical trial. Belfort MB, Review and Recommendations. Inder preterm neonates. Parad RB, Breeze Woodward LJ, Cherkerzian S, Pepin H, Ellard D, TE, de Vries LS, Ferriero DM, Grant PE, JL, Terrin N, Rogers LK, Salafia CM, Steele T, Fusch C, Grant PE, Inder TE. BMC Ment LR, Miller SP, Volpe JJ. J Pediatr. Greenough A, Davis JM. Pediatr Pediatr. 2021 Apr 9;21(1):167. doi: 2021 10; 237:276-287.e4. PMID: Pulmonol. 2021 Aug 26. PMID: 10.1186/s12887-021-02635-x. PMID: 33836708; 34146549. 34437765. PMCID: PMC8033746. A randomized controlled trial Acetazolamide Improves Right Carbonic anhydrase inhibition improves investigating the impact of maternal Ventricular Function and Metabolic pulmonary artery reactivity and nitric dietary supplementation with Gene Dysregulation in Experimental oxide-mediated relaxation in sugen-hypoxia pomegranate juice on brain injury in Pulmonary Arterial Hypertension. model of pulmonary hypertension. Christou infants with IUGR. Ross MM, Spyropoulos F, Michael Z, Finander B, H, Michael Z, Spyropoulos F, Chen Y, Rong D, Cherkerzian S, Mikulis ND, Turner D, Vitali S, Kosmas K, Zymaris P, Kalish BT, Khalil RA. Am J Physiol Regul Integr Comp Robinson J, Inder TE, Matthews LG. Sci Kourembanas S, Christou H. Front Physiol. 2021 06 01; 320(6):R835-R850. PMID: Rep. 2021 02 11; 11(1):3569. PMID: Cardiovasc Med. 2021; 8:662870. PMID: 33826428. 33574371. 34222363. Reading Aloud with Infants in the Neonatal Graded Approach to Intravenous Primary neuronal dysmaturation in Intensive Care Unit: A Unit-Based Program Dextrose for Neonatal preterm brain: Important and likely to Enhance Language Enrichment and Hypoglycemia Decreases Blood modifiable. Volpe JJ. J Neonatal- Support Early Foundational Relationships. Glucose Variability, Time in the Perinatal Med 14:1-6, 2021. Erdei C, Klass P, Inder TE. Am J Perinatol. 2021 Neonatal Intensive Care Unit, and Jun 07. PMID: 34100273. Cost of Stay. Sen S, Cherkerzian S, Mesenchymal stromal cell-derived Turner D, Monthé-Drèze C, syndecan-2 regulates the immune Abdulhayoglu E, Zupancic JAF. AJ response during sepsis to foster Pediatr. 2021 04; 231:74-80. PMID: bacterial clearance and resolution of 33338495. inflammation. Han J, Shi Y, Willis G, Imani J, Kwon MY, Li G, Ayaub E, Ghanta S, Ng J, Hwang N, Tsoyi K, El- Chemaly S, Kourembanas S, Mitsialis SA, Rosas IO, Liu X, Perrella MA.FEBS J. 2021 Aug 06. PMID: 34355516.

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

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 Elisa Abdulhayoglu, MD Katharine Herrick, MD Simon Manning, MD Sujatha Ramadurai, MBBS NICU Medical Director Medical Director of Well NICU Associate Medical Director of Special Care Nursery, Newborn Care Director Newton-Wellesley Hospital Director of Fetal Care Mandy Belfort Brown, Jennifer Benjamin, MD Sule Cataltepe, MD Margaret Everett, MD MD, MPH Director of NICU Follow-Up Medical Director of Newborn Director of Quality and Safety Director of Clinical Research Program Respiratory Care

Megan Connelly, MD Mohamed El-Dib, MD, FAAP Carmina Erdei, MD Tanzeema Hossain, MBBS Director of the Growth & Director of Education Associate Medical Director of Director of Neonatal Development Unit Well Newborn Care Neurocritical Care Lise Johnson, MD Anne (CC) Lee, MD, MPH Cindy H. Liu, Ph.D Carmen Monthe-Dreze, MD Co-Director of the Brazelton Director of Global Health Director of Developmental Director of Physician Well- Risk & Cultural Disparities Being Institute Program Richard Parad, MD, MPH Silvia Patrizi, MD Rimi Sen, MD Mollie Warren, MD Director of Newborn Director of Diversity, Equity & Director of Faculty Director of Transition to Home Medicine Genomic Program Inclusion Development Program & Physician Credentialing 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 Francheyska Silfa Fotios Spyropoulos, MD Melissa Woythaler, DO Mazara, MD Pediatricians Susan Beebe, MD Anna Cooley, MD Amanda Gallant, MD Kathryn MacMillan, MD

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

NICU Staff Speech and Language Pathology Pamela Dodrill, PhD, CCC-SLP, BCS-S Katherine Gibson, MS, CCC-SLP, BCS-S Emily Adams, MS, CCC-SLP, CNT, CLC Elizabeth (Lizzy) Kling , MS, CCC-SLP Respiratory Therapy Occupational Therapy Jessica Pacheco, MOT, OTR/L, CNT Physical Therapy Jessica Ahonen, PT, DPT, PCS, CNT, NTMTC Patricia Flynn, PT, CNT, NTMTC Sara Tenenholtz, PT, DPT, PCS, NTMTC Social Work Kara Belinsky, LICSW Marysabel Gomez, LICSW Susan Berliner, LICSW Andrew Piercey, LICSW Alicia Katz, LICSW Mara Sceery, RN Case Manager Maria Conley, Family Support Specialist Nutrition

NICU Staff Nursing Julie Cadogan, MSN, RNC-NIC, CNL, Interim Nursing Director


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

knowledgeADVANCING & care 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

A Tale of Twins... Getting to the NICU was an adventure for Laura and Ryan Mullins. When Laura was unexpectedly admitted to the Brigham at 25 weeks, Will & Jack, __ months their twins’ arrival appeared imminent. Meeting Dr. El-Dib shortly after admission was a tremendously reassuring first introduction to Will, Jack, mom Laura, & Dad Ryan, 1 the NICU amidst all the unknowns. month Despite the day-to-day outlook, Laura’s determination to remain Will & Jack, 3 months pregnant with the help of the special 8th Floor Antepartum unit led to an unexpected, but very fortunate, nine-week inpatient stay. Knowing the NICU was prepared for all scenarios, discussing the twins’ case at the twice daily coordination huddles, eased our concern considerably. As the weeks ticked by, the NICU’s quick responses to all of our questions gave us confidence that the twins would be getting the best possible care. When Laura delivered Will and Jack at 34 weeks, the long-anticipated transition to the NICU was flawless for the boys thanks to standout efforts by the nurses Felicia, Julie, Judith ,and Irina as well as doctors Inder, Van Marter, Manning, Brezinski, and Kaza who had helped along the way. Starting the night of the boys’ arrival in the NICU, the team was encouraging and involved us in every aspect of their care. At morning rounds, the team actively engaged Laura, knowing she is a pediatric nurse who had worked with BWH NICU alums herself. While Laura may have had a leg up initially, the team made sure Ryan was quickly proficient in feeding and changing diapers. In the first few days after the boys’ arrival, nurses Charlotte (the family's neighbor!) and Felicia decorated the room. This is something Laura has done for many of her patients, which made the room feel more like a nursery instead of a hospital. As soon as the boys were settled, the nurses, NPs and doctors turned to check on Laura and her recovery. While the process can feel daunting at times, the NICU’s focus on the whole family made everything easier. Will and Jack's primary nurse, Cheryl, helped us settle into a new routine very quickly. And, while it was never easy to leave at the end of the day, the calls to check-in with the nurses overnight were always something to look forward to. For Laura, being on the patient side was a new experience she looks forward to carrying into her own nursing practice. Looking back, it is humbling to know how many people at the Brigham supported us through the journey. Exactly 100 days from Laura’s admission, Will and Jack came home no worse for the wear, capping off a memorable summer at the Brigham! Will and TJahceksMtocrKyenonfa

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