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In The News: Pediatric Cancer, Fetal Surgery, Preterm Births, Post-PICU Physical Morbidity Risk, Tetralogy of Fallot

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Feb 19, 2021
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In the News

by mccannn [at] chop.edu (Nancy McCann)

As snow continues to fall in the Philadelphia area, stay warm and cozy by sitting fireside and reading about our investigators and their published research. In this week's In The News, learn what our Chief of the Division of Oncology, Stephen Hunger, MD, had to say in a "TODAY Show" article about pediatric cancer research. A new study analysis tells us about the benefits of fetal surgery for spina bifida patients. Discover who's studying the effects of the COVID-19 pandemic on preterm births, what socioeconomic factors are linked to neurodevelopment abnormalities in patients with tetralogy of Fallot, and who among us has received an Impact Grant from the American Association of Critical Care Nurses.

Stephen Hunger, MD, Chief of Division of Oncology, Featured in 'TODAY Show' Story

Stephen Hunger, MD

Stephen Hunger, MD

In a "TODAY Show" article, Stephen Hunger, MD, director of the Center for Childhood Cancer Research at Children's Hospital of Philadelphia, along with other pediatric cancer experts, explained why federal funding devoted to pediatric cancer research is so limited and discussed the huge impact childhood cancers have on families.

"Not all research is labeled as pediatric cancer or breast cancer or lung cancer," Dr. Hunger told "TODAY." "If you look at NCI funding, 4 percent is about the percentage that is devoted to what is clearly pediatric cancer. The issue is that there's a lot of basic research that is seeking to understand the mechanisms of how you develop cancer that may be applicable to pediatric cancer. But it's not labeled as such."

In addition to devoting more funding and resources to help advance treatments, the experts also agree families need a good deal of social support.

"The burden of pediatric cancer is much higher," Dr. Hunger added. "There's probably no more impactful thing that occurs in most families' lives than having a child diagnosed with a potentially fatal disease … People whose children die of cancer, they find a way to move on, but they're never the same."

Read the full article here.

Benefits of Fetal Surgery for Spina Bifida Extend Beyond Early Childhood

Scott Adzick, MD

Scott Adzick, MD

In a secondary analysis of a randomized clinical trial (MOMS2), researchers found that the physical functioning benefits of prenatal repair for the most severe form of spina bifida, myelomeningocele, persisted into school age for children with this condition. JAMA Pediatrics published the findings.

The research revealed that children with prenatal repair of the spinal cord were more likely than those who received postnatal repair to walk independently, go up and down steps, and perform self-care tasks such as using a fork, washing hands, and brushing teeth. They also had stronger leg muscles and walked faster than children who had their spina bifida surgery after birth.

"This study shows that the benefits of fetal surgery for spina bifida extend beyond early childhood and well into a child's first decade of life," said study co-author Scott Adzick, MD, CHOP surgeon-in-chief and director of its Center for Fetal Diagnosis and Treatment. "This is especially important because of previously raised concerns that the advantages from fetal surgery may decrease over time. Contrary to those concerns, there appears to be a long-term benefit from neural protection in utero."

Learn more.

What Are Effects of Population Level Exposures and the Pandemic on Preterm Births?

Heather Burris, MD, MPH

Heather Burris, MD, MPH

The research interests of Heather Burris, MD, MPH, an attending neonatologist at CHOP, center around preterm birth disparities, and how some physical, environmental, and social factors are responsible for the differences seen in birth outcomes across different ethnic and racial groups.

"So, things like the air we breathe, the water we drink, or our neighborhood exposures, or the stressors of experiencing discrimination, all of those things [must be] taken into account," Dr. Burris said in a WHYY story. "And when you have large differences in population level experiences and exposures, we end up with large population differences in health outcomes."

With a new grant, Dr. Burris will co-lead a team of investigators to identify some of these population-level exposures, which could explain the differences being seen in population levels of preterm birth. They will also study the effects of the COVID-19 pandemic on preterm birth and perinatal care both in Philadelphia and nationally.

"The COVID-19 pandemic has led to profound changes in the way prenatal care is being delivered and utilized, on top of changes to the way pregnant women lead their everyday lives," Dr. Burris continued. "This funding will allow us to explore the effect these shifts are having on preterm birth and perinatal care and whether those effects vary by socioeconomic or demographic groups."

Postdoctoral Diversity Fellow, Mallory Perry, PhD, RN, Awarded Impact Grant

Mallory Perry, PhD, RN

Mallory Perry, PhD, RN

Mallory Perry, PhD, RN, a nurse scientist and postdoctoral fellow for academic diversity at CHOP's Research Institute, received an American Association of Critical Care Nurses Impact Grant. The study "Pediatric Recovery after Sepsis Treatment in the Pediatric Intensive Care Unit (PERSIST-PICU)," will utilize symptom science approaches to explore the potential role of inflammation as it pertains to post-PICU physical morbidity in critically ill children with and without sepsis. Symptom science is a method used to focus on the symptom experience, including biology of the underlying symptom, as opposed to the disease or illness itself.

Findings will aid in the development of a multivariable model to identify physical morbidity risk after PICU discharge. Identification of at-risk critically ill children will provide an opportunity for early intervention to optimize their physical recovery.

"As a pediatric critical care nurse, I understand that many of the therapies and treatments we provide, while necessary and life-preserving, can have long-term effects — both good and bad — on the children we care for," Dr. Perry said. "As a nurse scientist, it is my goal to understand what happens to our kids who leave the pediatric intensive care unit, after they go home. The NICU does a great job of this, following-up on their preemies, but in the PICU it is often difficult. With this research, I hope to understand the symptoms experienced by children who survive the PICU and the underlying mechanisms of these symptoms."

Learn more about Dr. Perry in this Cornerstone Q&A.

Socioeconomic Factors Linked to Neurodevelopment Deficits in Patients With TOF

Laura Mercer-Rosa, MD, MSCE

Laura Mercer-Rosa, MD, MSCE

CHOP researchers have identified socioeconomic factors and disease complexity that is correlated with abnormal neurodevelopment in patients with tetralogy of Fallot (TOF), a complex condition involving four distinct defects of the heart and nearby blood vessels present at birth. Pediatric Cardiology published the findings.

After analyzing 49 patients who presented to CHOP's Cardiac Kids Developmental Follow-up Program (CKDP) between 2012 and 2018, the researchers found 43 percent of patients had deficits in the earliest neurodevelopmental screening test. They also discovered several neighborhood-level factors related to poverty were associated with greater odds of abnormal neurodevelopment, including higher unemployment rates, lower median household income, and a larger proportion of individuals below 100 percent of the poverty line.

"We hope this work opens the door for socioeconomic factors to be taken into account in the care of our patients with TOF," said senior author Laura Mercer-Rosa, MD, MSCE, an attending cardiologist in CHOP's Cardiac Center.

Other CHOP co-authors include: Emmanuelle Favilla, MD; Jennifer Faerber; Lyla Hampton, PhD; Chitra Ravishankar, MD; J. William Gaynor, MD; Alisa Burnham, MD; and Daniel Licht, MD.

ICYMI

Catch up on our headlines from our Feb. 5 In the News:

  • Study Assesses Concordance Between Preoperative SARS CoV-2 Testing and Surgery Day
  • Will Bailis, PhD, Recognized With Distinguished Investigator Award
  • Defects in Mitochondria May Predispose Patients to Autism Spectrum Disorder
  • New Study Finds Young Autistic Drivers Crash Less Than Non-autistic Peers

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