Stephanie Berger, M.D., and Cassi Smola, M.D., are co-investigators in an “Open Notes” study evaluating curriculum needs for medical students with medical records now available to patients via the patient portal.

Dr. Berger and Meenu Sharma, D.O., pediatric hospital medicine (PHM) fellow, are investigating variation in evaluation and clinical outcomes for infants with hypothermia as part of a multi-site study.

Dr. Berger is also involved in a multi-site study, “Assessment of Alternative Approaches for Delivering Video-Based Learning Utilizing the Flipped-Classroom Method in the Pediatric Clerkship,” which is completing data analysis.

Meghan Hofto, M.D., MPH, is a co-investigator on a National Institutes of Allergy and Infectious Diseases multi-institution study of community-acquired pneumonia in children from six months to five years of age, comparing outcomes in patients assigned to five days of antibiotic to those receiving the standard 10-day antibiotic course. This work is pending publication in JAMA Pediatrics.

Nichole Samuy, M.D., MBI and Paul Scalici, M.D., served as site co-investigators for the KIDCARE Trial, a multi-site, national comparative effectiveness study of infliximab versus a second dose of intravenous immune globulin (IVIG) for Kawasaki disease refractory to initial IVIG treatment. The study is slated for publication in The Lancet in October 2021. Drs. Samuy and Scalici are also the site co-investigators for the CHARMS study, which is a multi-site, national observational data collection study investigating the relationship between Kawasaki disease and COVID-19 associated multisystem inflammatory syndrome in children. The CHARMS study just closed enrollment, and data analysis is ongoing. Both studies received funding by the Patient-Centered Outcomes Research Institute (PCORI).

Erin Shaughnessy, M.D., MSHCM, serves as a co-investigator for a large survey cohort study of workforce trends for pediatric hospital medicine (PHM) sponsored by the American Academy of Pediatrics. As pediatric hospital medicine is a relatively young field, ongoing study of workforce trends is key to informing successful and sustainable program development.

Dr. Shaughnessy continues work to advance knowledge regarding pediatric vascular access best practices for hospitalized children, building on the miniMAGIC (Michigan Appropriateness Guide for Intravenous Catheters in Pediatrics) guideline published in Pediatrics in 2020. One evidence gap noted in the miniMAGIC guideline is around appropriate use of midline catheters in pediatrics. Dr. Shaughnessy is part of a research team conducting a scoping review of midline catheter use in pediatrics.

Cytomegalovirus (CMV) is a major source of disability in children due its ability to cause hearing loss, cognitive impairment, cerebral palsy and impaired vision in infants born with congenital CMV infection. Robert Pass, M.D., has devoted much of his professional life to the study of congenital cytomegalovirus (CMV) infection and development of approaches to prevention of maternal and congenital CMV infection. Dr. Pass led the first study of a CMV vaccine that showed promise for prevention of CMV infections in young women of childbearing age, a result that led to increased international interest in CMV vaccine development. He also served on the Scientific Advisory Board for Moderna’s CMV mRNA vaccine, which entered a Phase III clinical trial this fall. Over the past 10 years, Dr. Pass has worked with the CMV Subcommittee of the Maternal and Fetal Medicine Units (MFMU) network, a multi-site research collaboration. This year, the research network completed a randomized clinical trial of CMV hyperimmune globulin in pregnant women with primary CMV infection. Previous studies reported conflicting results as to the efficacy of this expensive intervention for prevention of congenital CMV infection. The current MFMU study screened more than 200,000 pregnant women for CMV infection and randomized 399 to CMV hyperimmune globulin or placebo. There was not a statistically significant difference between groups in rates of the primary outcome of congenital infection or fetal death related to CMV. This very important result does not support the use of CMV hyperimmune globulin in pregnant women to prevent congenital CMV infection.

Active pediatric COVID-19 pneumonia and multisystem inflammatory syndrome in children (MIS-C) are two disease processes requiring rapid diagnosis and different treatment protocols. Drs. Scalici and Samuy participated in this single center retrospective chart review study aimed to distinguish active pediatric COVID-19 pneumonia and MIS-C using presenting signs and symptoms, patient characteristics and laboratory values. The study found that most MIS-C patients were healthy at baseline, with most COVID-19 patients having at least one underlying illness. Fever, rash, conjunctivitis and gastrointestinal symptoms were predominant in the MIS-C population, whereas COVID-19 patients presented with predominantly respiratory symptoms. The two groups were similar in duration of symptomatic prodrome and exposure history to the SARS-CoV-2 virus, but MIS-C patients had a longer duration between presentation and exposure history. COVID-19 patients were more likely to have a positive SAR-CoV-2 PCR and to require respiratory support on admission. MIS-C patients had lower sodium levels, higher levels of C-reactive protein, erythrocyte sedimentation rate, d-dimer and procalcitonin. COVID-19 patients had higher lactate dehydrogenase levels on admission. MIS-C patients had coronary artery changes on echocardiography more often than COVID-19 patients.

Featured Quality Improvement Initiatives

Dr. Berger serves as a faculty mentor for a resident quality improvement project to improve the ordering and delivery of lactation meal trays for breastfeeding mothers whose children are admitted to the hospital.

Adolfo Molina, M.D., MSHQS, is site leader for an AAP Value in Inpatient Pediatrics multi-institutional quality improvement initiative to improve appropriate antibiotic selection and duration for three common pediatrics infectious diseases (community-acquired pneumonia, skin and soft tissue infections, urinary tract infections). Erinn Schmitt, M.D., MEd, and Dr. Hofto, as well as representatives from the Divisions of Pediatric Infectious Disease, Pediatric Emergency Medicine and Pharmacy are all contributing to this important effort.

Dr. Molina also continues work started by former fellow Dr. Samantha Hanna to address food insecurity in children admitted to Children’s of Alabama. A positive screen triggers an automatic social work evaluation that includes free meals for families during hospitalization, assistance with WIC/SNAP application and a list of food banks.

Lauren Nassetta, M.D., and colleagues in the Division of Pediatric Emergency Medicine and Pediatric Endocrinology & Diabetes are examining the impact of implementation of a standardized care pathway for diabetic ketoacidosis on known health disparities. Early results show that racial disparities in care outcomes, such as time until IV fluid administration and time to closure of anion gap, were mitigated by implementation of the pathway.

Mary Orr, M.D., MPH DTM&H, is the site lead in the Value in Inpatient Pediatrics HIFLO (High flow Interventions to Facilitate Less Overuse). This is a multidisciplinary group with other physicians from hospital medicine (Emily Casey) and emergency medicine (Valerie Davis, Kathy Monroe, Christina Cochran, Heather Mitchell), respiratory therapy and nursing leadership. The aim is to reduce high flow initiation in patients with mild to moderate bronchiolitis by 30%.

Dr. Orr is also the site lead of the Eliminating Monitor Overuse (EMO) Hybrid Effectiveness-Deimplentation Trial. This is a multi-site research study that aims to test a usual approach unlearning deimplentation strategy vs. an enhanced unlearning + substitution deimplementation strategy to decrease continuous pulse oximetry monitoring in patients with bronchiolitis who are not on supplemental oxygen.

Dr. Schmit is the chair of the Safe Sleep Task Force at Children’s of Alabama. This multidisciplinary task force has worked to improve practices at Children’s of Alabama and to educate parents and staff on the importance of safe sleep recommendations for infants. The task force has received both grant and donor funding to purchase sleep sacks as a discharge gift for all admitted infants and to purchase crib caddies to keep extraneous care items out of cribs.

Meenu Sharma, D.O., PHM fellow mentored by Dr. Molina, is undertaking an initiative to improving the rates of influenza and COVID-19 vaccination for eligible children on the PHM service. Dr. Sharma leads a collaborative team including resident, pharmacy and nursing representatives.

Michelle Veters, M.D., PHM fellow mentored by Dr. Berger, is leading a quality improvement initiative to improve timely completion of medical student evaluations by PHM faculty for M3s in the pediatric clerkship. This initiative is utilizing innovative interventions, such as a recognizing timely completion with a shark trophy and public reminders for tardy evaluators.

Featured Clinical Innovation

Drs. Scalici and Nassetta led a divisional task force to redesign an inpatient experience to mimic community hospital practice for education of PHM fellows and residents. The new team, called “Orange team,” has been an early favorite for trainees. The collaborative QI team continues to incorporate resident and faculty feedback to optimize the experience.

Acad Med. 2021 Jul 1;96(7S):S64-S69. Constructing a Validity Map for a Workplace-Based Assessment System: Cross-Walking Messick and Kane. Benjamin Kinnear, Matthew Kelleher, Brian May, Dana Sall, Daniel P Schauer, Daniel J Schumacher, Eric J Warm.

Cureus. 2021 Jun 24;13(6):e15893. Acute Appendicitis Associated With Multisystem Inflammatory Syndrome in Children. Meghan E Hofto, Erinn O Schmit, Meenu Sharma, Nichole Samuy.

Hosp Pediatr. 2021 Jul 23;hpeds.2020-005108. Acute Kidney Injury Among Children Admitted With Viral Rhabdomyolysis. Hannah M Gardner, David J Askenazi, Jennifer A Hoefert, Alexis Helton, Chang L Wu.

J Hosp Med. 2021 Jan;16(1):31-33. Gender Distribution in Pediatric Hospital Medicine Leadership. Jessica M Allan, Juliann L Kim, Shawn L Ralston, Nicole M Paradise Black, Rebecca Blankenburg, Erin E Shaughnessy, H Barrett Fromme.

N Engl J Med. 2021;385:436-44. A trial of hyperimmune globulin to prevent congenital cytomegalovirus infection. Hughes, BL, Clifton, RG, Rouse, DJ, Saade, GR, Kinsmoor, MJ, Reddy, UM, Pass, R, and others.

Pediatr Rheumatol Online J. 2021 Feb 24;19(1):21. Distinguishing active pediatric COVID-19 pneumonia from MIS-C. Daniel D Reiff, Melissa L Mannion, Nichole Samuy, Paul Scalici, Randy Q Cron.

Meghan Hofto, M.D., MPH

• Dr. Hofto serves as co-chair of the Global Health Special Interest Group of the Academic Pediatric Association.
• She was recently elected as Co-Chair of the Subcommittee on Global Health for the American Academy of Pediatrics Section on Global Health.
  

Brian May, M.D.

• Dr. May served as a member of the American Council of Graduate Medical Education Pediatric Milestones Working Group, whose goal is to review and revise milestones for pediatric resident education.
• Dr. May also serves as an ACGME Pediatric Program Representative in the GME Stakeholder Congress on Preparing Residents and Fellows to Manage Pain and Substance Use Disorder (SUD).

Erin Shaughnessy, M.D., MSHCM

• Dr. Shaughnessy was selected for membership to the American Pediatric Society.
• She completed a term as co-chair of the APA Hospital Medicine Special Interest Group in 2021 and service on the Pediatric Hospital Medicine meeting planning committee.
• Dr. Shaughnessy continues as a deputy editor for Reviews and Perspectives at the Journal of Hospital Medicine and serves as one of two PHM representatives for the Council of Pediatric Subspecialties.

Cassi Smola, M.D.

• Dr. Smola serves on the Alabama American Academy of Pediatrics Board as a resident liaison.

Susan Walley, M.D.

• Dr. Susan Walley departed UAB for a position as division chief of Pediatric Hospital Medicine at Children’s National in Washington, DC.
• Dr. Walley was recognized with the national Clinical Excellence Award at the Pediatric Hospital Medicine meeting in 2021.

The UAB Pediatric Hospital Fellowship program celebrates its 10th anniversary. Our ACGME accredited fellowship program is currently led by Chang L. Wu, M.D., MSCR, as program director and Erinn Schmit, M.D., MEd, recently promoted to associate program director. Adolfo Molina,, M.D., MSHQS was also officially named a part of the leadership team as a fellow advocate.
 
The fellowship successfully graduated two fellows in the last year. Since the program’s inception, every graduate of the program has been successful in obtaining an academic hospitalist appointment immediately upon graduation. In 2021, Dr. Alexandra Healy joined faculty at the Children’s Hospital of Philadelphia, and Dr. Samantha Hanna joined faculty at Saint Louis University. Additionally, fellow alumnus Rebecca Cantu (c/o ’16) was promoted to associate professor at the University of Arkansas for Medical Sciences and was also named program director for their inaugural PHM Fellowship Program.
 
We welcomed the addition of two excellent fellows—Dr. Elizabeth Mertens from the University of Tennessee Memphis Pediatrics Residency Program and Dr. Meghan Harrison from our very own University of Alabama at Birmingham. The fellowship continues to be very busy in a highly competitive subspeciality. We received 46 applications for its two fellowship positions, interviewing 26 applicants this year. All interviews were performed virtually in light of the ongoing pandemic.
 
In the last year, the fellowship celebrated four fellowship publications: Hannah Gardner for “Acute Kidney Injury Among Children Admitted With Viral Rhabdomyolysis,” published in Hospital Pediatrics; Michelle Veters for “Clinical Guideline Highlights for the Hospitalist: 2020 Focused Updates to Pediatric Asthma Management,” published in Journal of Hospital Medicine; Cassi Smola for her work “Utilization of Monitored Beds for Children Admitted with Unintentional Poisonings” accepted for publication in Pediatric Emergency Care; and Jennifer Hoefert for “De-Escalation of High-Flow Respiratory Support for Children Admitted with Bronchiolitis: A Quality Improvement Initiative,” accepted for publication in Pediatric Quality and Safety.

2021–2022 Fellows

Meghan Harrison, M.D.
First-Year Fellow
Pediatric Residency: UAB

Elizabeth Mertens, M.D.
First-Year Fellow
Pediatric Residency: University of Tennessee, Memphis

Michelle Duplantier Veters, M.D.
Second-Year Fellow
Pediatric Residency: Louisiana State University

Meenu Sharma, D.O.
Second-Year Fellow
Pediatric Residency: Memorial Health University, Savannah

Program Directors

Chang Wu, M.D., MPH
Program Director

Erinn Schmit, M.D., MEd
Associate Program Director

Program Coordinator

Heather Kirk