Top 15 Children's Hospitals in Innovation and Technology
As the pandemic pushed pediatric hospitals to the brink in 2020—some even took in adult patients—their research continued on. We surveyed 50 leading children's hospitals, inquiring about innovations, response to the pandemic, and technology used on a regular basis. Members of the Parents advisory board David L. Hill, M.D., Hugh Sampson, M.D., and Darshak Sanghavi, M.D., then helped us determine the best of the best out of more than 200 innovations that were submitted.
From a device that eases stomach pain to a promising treatment for rare diseases, here are the biggest breakthroughs in kids' health we found happening in hospitals around the country that could redefine how doctors care for children.
Nationwide Children's Hospital
What they're working on: An Appendectomy Alternative
There's now a nonsurgical fix for a condition that affects upwards of 80,000 kids every year—and a team of doctors at Nationwide Children's Hospital, in Columbus, Ohio, laid the groundwork. A decade ago, the two cofounders of its Center for Surgical Outcomes began exploring whether some kids with appendicitis could get back to normal with antibiotics alone, cutting the risk of complications and recovery time, not to mention family stress. They recently confirmed their hunch in a study of 1,000-plus kids with early, uncomplicated appendicitis from ten medical centers: Nearly 70 percent of the kids receiving antibiotics (an IV for at least 24 hours in the hospital and then pills at home afterward) didn't require their appendix to be removed during the one-year study period.
"About one in four patients we treat for appendicitis meets the criteria for the nonsurgical approach, and we give their families that option at the hospital now," says study co-leader Katherine Deans, M.D. A major medical journal recently published the data, which means more hospitals may adopt this strategy going forward, according to Dr. Deans.
Children's Mercy Kansas City, in Missouri
What they're working on: A Scale-Free Well Visit
A device called a MUAC z-score tape, developed by Children's Mercy Kansas City, in Missouri, may make stepping on a scale at well visits obsolete. A provider wraps the measuring tape around a child's upper arm and compares the number with the tape's indicators for age and gender. First designed for malnutrition screening in world areas where scales aren't readily available, the tape has since been used by hospitals on more than 10,000 patients. It's especially helpful when evaluating kids who feel self-conscious about their weight, says Susan Abdel-Rahman, Pharm.D., director of health-care innovation at Children's Mercy Research Institute. Hallmark helped with the design and manufacturing; it's now being mass-produced.
Children's Healthcare of Atlanta
What they're working on: An App to Detect Anemia
If you need to keep tabs on your kid's iron level—or your own, for that matter—an app developed at Children's Healthcare of Atlanta can help avert some blood tests. Researchers there found that fingernail color can be a reliable measure of hemoglobin (found in red blood cells where iron is stored) in people of any skin tone. They then worked out an algorithm for an app that can provide an accurate result just by snapping a nails selfie. (No nail polish, of course.) They expect to launch AnemoCheck Mobile on the App Store and Google Play by the end of the year. Users will be able to download the app free and buy tests within the app for about $1 each.
While the app shouldn't replace a doctor's diagnosis of iron-deficiency anemia, it can help monitor the condition affecting 20 percent of kids in the U.S. "If you take an iron supplement, it may help you track whether it's working," says Wilbur Lam, M.D., Ph.D., a hematologist-bioengineer. "It will also be useful for doing telemedicine appointments."
Texas Children's Hospital, in Houston
What they're working on: The Future of Fetal Surgery
Operating on the birth defect spina bifida in the womb rather than after birth doubles the chance that a child will walk independently. But the classic in utero surgery increases the risk of complications and always requires a cesarean. Doctors at Texas Children's Hospital, in Houston, have developed a less invasive "fetoscopic" method, even creating special instruments. They place two small access ports in the wall of the uterus and thread in tiny surgical instruments to close the hole that exposes the spinal cord. "With this approach, there's less scarring and a lower risk of uterine rupture and preterm delivery, and half of the nearly 100 patients we've done this on have delivered vaginally," says obstetrician Michael A. Belfort, M.D., Ph.D., who developed the technique.
Lucile Packard Children's Hospital Stanford
What they're working on: Big Hearts for Small Patients
For every child who needs a heart transplant, there are many more patients on the wait list than there are hearts from kid donors to go around. Lucile Packard Children's Hospital Stanford, in Palo Alto, California, has changed its approach for evaluating whether a donor organ will fit a child, allowing it to find a match faster. "We take hearts that we wouldn't have looked at five years ago because we thought they'd be too large," says John Dykes, M.D., a pediatric cardiologist. "We've successfully given a heart to a patient from a donor who weighed three times more." Knowing whether the heart from a bigger patient will fit in a child's chest cavity comes courtesy of the new standard to make a 3-D model of every transplant patient's heart. "Then our lab, which is available 24/7, can compare the model with a scan from the potential donor and have an answer of whether it will fit the child within 20 minutes."
Children's Medical Center at NYU Langone Hospital—Long Island
What they're working on: Preemie Feeding Solutions
Many preemies who weigh less than 3 1/2 pounds at birth have trouble swallowing breast milk or formula because their sensory pathways aren't mature. "Milk can end up in their lungs, causing inflammation and pneumonia," says Nazeeh Hanna, M.D., chief of neonatology at Children's Medical Center at NYU Langone Hospital—Long Island. After reading a journal article about adult stroke survivors who had less trouble swallowing cold liquids than warmer ones, Dr. Hanna decided to try the approach in hospitalized preemies with a feeding problem known as dysphagia. In his study, feeding milk straight from the fridge rather than warming it up reduced the rate of dysphagia from 71 to 26 percent. "The cold receptors in a baby's throat activate a pathway that increases the chance the brain will get the feeding signal," he explains. And babies don't need cold milk long-term. By the time they leave the hospital, feeding them directly from the breast or warming up a bottle is A-OK.
Children's Hospital of Philadelphia
What their working on: Sleuthing for a Diagnosis
When test after test can't explain why a child is sick, Children's Hospital of Philadelphia may be able to crack the case. Its Roberts Individualized Medical Genetics Center has provided answers to more than 1,000 patients. "We can sequence a child's genome and sometimes have a diagnosis within days," says Joseph W. St. Geme, M.D., physician-in-chief. Teams across the hospital are focused on personalized approaches. For example, when they found a genetic mutation that caused breathing trouble and swelling in a 10-year-old patient, they replicated the condition in a zebra fish and tested medicine that had been approved for an unrelated condition. The results looked promising, and they gave the medicine to the child. "His symptoms subsided within three months," says Dr. St. Geme. "He rides his bike, plays basketball, and goes to school."
Dayton Children's Hospital
What they're working on: A Sensory-Friendly Surgery Experience
Many kids have big feelings before an operation, but it's especially hard on those with autism or other special needs. "More than half of kids with sensory disorders become so upset as they're getting ready for surgery that we have to give them medication to calm them down," says Sean Antosh, M.D., a pediatric anesthesiologist at Dayton Children's Hospital. He teamed up with a nurse who used to teach kids with autism to create new pre-op rooms and plans. The softer approach starts days before, during a phone call with parents in which staff enter the child's color and music preference into their electronic medical record. On surgery day, kids come to a space with familiar music and LED lighting in their fave hue. They play on color-changing floor tiles or take headphones, fidget spinners, or weighted blankets from the sensory cart. When it's time for surgery, kids drive a remote-controlled airplane to another room and watch a space-themed video as they receive anesthesia. Says the parent of one patient: "My daughter used to scream, but this time she was so distracted."
Children's Hospital Los Angeles
What they're working on: A Plan for Pain
National pain-management guidelines for kids who've had surgery weren't even a thing until a month ago. That's when a team led by Children's Hospital Los Angeles released 20 strategies that address risks of prescription opioid use, effective substitutes, and education on safety, storage, and disposal of unused pills so doctors and families can all be on the same page. Surprisingly, the dentist's office emerged as a trouble spot. "There's a lot of potential for misuse following any procedure, such as orthopedic surgery or wisdom-tooth extraction," says pediatric surgeon Lorraine Kelley-Quon, M.D. The bottom line: While the guidelines encourage doctors to bring up pain management before a procedure, parents can prompt a discussion too.
Michigan C. S. Mott Children's Hospital
What they're working on: A Better Way to Track Tumors
For kids receiving treatment for glioma, a type of brain tumor, scans don't give a clear picture of whether the radiation is working. "Radiation can create a swelling that looks similar to tumor growth," says Carl Johannes Koschmann, M.D., a pediatric oncologist at the Michigan C. S. Mott Children's Hospital, in Ann Arbor. But by using a handheld genetic sequencing device, C. S. Mott's doctors have been able to monitor the amount of tumor DNA in the spinal fluid of more than 130 patients. It gives them a better idea of how a treatment is working and the way a tumor's mutations are changing over time—a clue they may need for tweaking treatments.
St. Jude Children's Research Hospital
What they're working on: An Immune System Builder
After two decades of trying to give a normal life to kids with X-linked severe combined immunodeficiency (sometimes called bubble boy disease) by inserting a correct copy of a gene into their stem cells, doctors at St. Jude Children's Research Hospital, in Memphis, have found the elusive answer. In a landmark study, 15 of 16 patients developed a working immune system within four months of receiving genetic material with a "fire wall" against leukemia, a devastating complication in earlier trials. "My patients can finally go to school or out with their parents," says Ewelina K. Mamcarz, M.D., coleader of the trial. "They catch colds like other kids but have the immune system to fight them."
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What they're working on: A Stomach Pain Soother
Kids with chronic stomach pain are feeling relief thanks to a new FDA-approved therapy that was developed by Katja Kovacic, M.D., a gastroenterologist at Children's Wisconsin, in Milwaukee. In one study of tweens and teens with irritable bowel syndrome, more than 65 percent of patients who received a treatment called auricular neurostimulation reported feeling less nausea, stomach pain, and headaches. Kids are fitted with a small device to wear behind one ear for about a week at a time. They remove it for a few days and then start again, keeping it on for a total of about a month in most cases. The device delivers tiny electrical impulses that are thought to reduce the firing of pain-causing neurons.
UPMC Children's Hospital of Pittsburgh
What they're working on: Diabetes Progress
There hasn't been a new treatment for type 1 diabetes since insulin was first used, almost 100 years ago. That's why there's excitement at UPMC Children's Hospital of Pittsburgh about a patented discovery that could spell the welcome end to daily needle jabs. Using gene therapy, doctors working on lab and animal studies have figured out how to reprogram cells in the pancreas so they become functional and produce insulin. "We've knocked the insulin requirement of diabetic monkeys almost to zero," says George K. Gittes, M.D., chief of pediatric surgery. "Now we're working with the FDA to get trials on people underway by next year."
Seattle Children's Hospital
What they're working on: Cancer Fighters
About half of kids whose acute lymphoblastic leukemia didn't respond to traditional treatments have found a cure in CAR T-cell therapy, a technique where their immune cells are removed, reengineered to fight the disease, and returned. Now researchers at Seattle Children's Hospital are working to improve the success rates for children with leukemia, as well as introducing the CAR T-cell treatment for neuroblastoma and brain cancer. "We built a 500,000-square-foot facility to manufacture the T cells and came up with a vaccine that increases their longer-term effectiveness," says Michael Jensen, M.D., chief therapeutics officer.
Boston Children's Hospital
What they're working on: Sickle Cell Strategies
For children who don't respond to the traditional treatments for sickle cell disease, an inherited disorder most prevalent in Black families, a gene-therapy strategy at Boston Children's Hospital has doctors feeling optimistic. Long ago, researchers pinpointed the problem: a mutation in a gene that makes part of hemoglobin, the iron-rich compound in red blood cells that delivers oxygen to the body. Now they've figured out how to program a child's own stem cells to make a type of healthy hemoglobin normally produced by the fetus and in infants. "In our pilot study, it's working as anticipated, increasing fetal hemoglobin levels without unexpected adverse side effects," says researcher Erica Esrick, M.D. In the next few months, the hospital will lead a larger study that includes patients at medical centers around the country.
This article originally appeared in Parents magazine's January 2021 issue as "Kids' Hospitals Leading the Way." Want more from the magazine? Sign up for a monthly print subscription here