Medical News – Spring 2021

Connecticut Children's Care Network: Partnering to Enhance Pediatric Health Outcomes

Led by pediatricians, the Care Network focuses on providing personalized support to pediatric practices to help enhance quality of care, increase efficiency of practice, reduce overall costs, and improve health outcomes for all children.

Connecticut Children’s Care Network is the only provider network in Connecticut dedicated exclusively to child health and well-being. The Care Network consists of community primary care providers, pediatric specialists, and a nationally-ranked children’s health system. As the network’s medical director, I am excited to share more information about the value the Care Network brings to pediatric practices.

Led by pediatricians, the Care Network focuses on providing personalized support to pediatric practices to help enhance quality of care, increase efficiency of practice, reduce overall costs, and improve health outcomes for all children. To date, the Care Network has made a measurable impact on member practices.

“We were thrilled with the opportunity to partner with Connecticut Children’s and independent pediatricians across the state and Western Massachusetts to work together on improving quality and negotiating fair insurance contracts that are all exclusively focused on pediatrics,” said Jennifer Schwab, MD, a pediatrician and partner in Rocky Hill Pediatrics, which is a Care Network member practice. “We are able to stay independent and thrive, and enjoy the opportunity to collaborate on quality programs with other practices. We share best practices, learn from each other and support each other.”

Currently, the Care Network consists of 156 pediatric providers affiliated with 28 primary care practices that see patients at 35 locations in Connecticut and Western Massachusetts. We have contracts with all major insurers. Our value-based contracts include shared savings for quality care. In addition, the Care Network is the only pediatric network in the Connecticut Medicaid Person Centered Medical Home Plus (PCMH+) program.

“We are stronger together by contracting with other pediatric groups that inherently have the same interests as we do,” said Dena Hoberman, MD, FAAP, of Pioneer Valley Pediatrics, a Care Network member practice. “We are stronger together in sharing information on trends within our communities and being governed by the very pediatricians who are doing the work in the community.”

Please contact me to learn more about Connecticut Children’s Care Network. You can reach me by phone at 860.837.5125 or via email at DKrol@connecticutchildrens.org.


David Krol, MD, MPH, FAAP, is medical director of Connecticut Children’s Care Network.

Learn more

Nearly 100 Attend First of Nine-Part Behavioral Health Learning Community Series

By: Ryan Calhoun, Executive Director, Connecticut Children’s Care Network

As the pandemic continues to impact children, families and clinicians across the country, behavioral health is emerging as the next health crisis, especially in pediatrics. Families continue to find that hospitals and offices aren’t equipped to handle children and adolescents in crisis.

One of the primary contributors to this challenge is that healthcare teams are not specially trained to manage behavioral problems, which leaves families with few options when they’re in need.

“The first Behavioral Health Learning Community gave an excellent high level view of the scope of the mental health issues pediatricians frequently face with their patients, and presented some initial screening scales to help identify patients needing further care,” said Richard Segool, MD, FAAP. “In subsequent sessions, further tools will be presented to better identify patient’s specific mental health needs, and to sharpen our skills in providing them with appropriate care. One main goal of these Learning Communities is to enhance pediatricians’ skills and comfort zone in providing mental health care to our patients.”

Dr. Segool is one of 90 pediatricians and their office staff who attended Connecticut Children’s Care Network’s first session of their nine-part Behavioral Health Learning Community series aimed to help pediatricians and their offices identify, assess and treat ADHD, Anxiety and Depression.

The Learning Community series is being hosted in partnership with Boston Children’s Hospital and their psychiatrist-in-chief, David R. DeMaso, MD and Heather Walter, MD, MPH, who is also a psychiatrist and the medical director for Boston Children’s Accountable Care Organization, Pediatric Physicians Organization at Children’s (PPOC).

PPOC has integrated behavioral health clinicians into their pediatric primary care offices across the state of Massachusetts. Their outcomes were recently published in the Journal of Pediatrics and this learning community is sharing those best practices with Connecticut Children’s Care Network pediatricians and their behavioral partners such as The Village for Families and Children.

“It’s great that we’re focusing on behavioral health issues affecting primary care, as it’s an area typically underappreciated,” said Steven Moore, PhD, vice president of New Business Development at The Village for Families and Children. “The comments from individual pediatricians that occurred in the breakout sessions were as important and helpful as the overall presentation.”

The presentation of the first session focused on understanding the rationale and the stepped model for collaborative behavioral health in primary care. It also detailed the components of a focused behavioral health assessment in primary care. The next eight sessions will focus on providing pediatricians training on screening, assessment and treatment of anxiety, depression and ADHD.

“I’m so excited to start the journey of learning more about how to integrate behavioral health into my practice in Bristol, CT. It will be great to learn which screening tests are best for early identification of mental health problems in children. I am also excited to learn how to navigate tools to treat both in my office as well as local resources for referral. Doing this as a network will help us ensure proper communication and is in line with our goal to make the children in Connecticut even healthier,” said Julie Schiff, MD, pediatrician at Pediatric Associates LLC in Bristol.

Please contact the executive director of the Connecticut Children’s Care Network if you’d like to attend one of the remaining sessions in 2020. You can reach him by email at RCalhoun@connecticutchildrens.org or by phone at 904.485.0124.

Women in Surgery Podcast: Operating at a Time of Opportunities and Challenges

The number of female surgeons in the United States is growing; however, it remains a field heavily dominated by men. In an effort to discuss and work to eliminate barriers, our Women in Surgery group at Connecticut Children’s has launched a new podcast to showcase how we operate.

Women in Surgery PodcastIn this podcast, Connecticut Children’s aims to share our successes, challenges and real-life experiences with surgeons, physicians, and future healthcare professionals beyond our pediatric health system – and of course, to support each other.

The Women in Surgery Podcast series is part of Connecticut Children’s Diversity, Equity and Inclusion journey, in which we are working to make sure all team members feel respected, a sense of belonging and empowered to be the best we can be. It is now available on the Connecticut Children’s website.

In our first episode, six of our women surgeons at Connecticut Children’s share their thoughts on what’s known as imposter syndrome, which is defined by the Harvard Business Review as “a collection of feelings of inadequacy that persist despite evident success.”

In this episode, the surgeons share moments in their lives when
they felt like an imposter – not only in their profession but also in their personal lives. Some of their experiences occurred during life milestones such as starting a new job, taking on new
responsibilities, and relocating to a new area.

Connecticut Children’s surgeons Janine Collinge, MD, a pediatric ophthalmologist, Allison Crepeau, MD, a pediatric orthopedic sports surgeon, Cara DeBenedictis, MD, a pediatric ophthalmologist, Nancy Grover, MD, a pediatric otolaryngologist, Kristan Pierz, MD, a pediatric orthopedic surgeon, and Raina Sinha, MD, MPH, FACC, a pediatric and adult congenital cardiac surgeon, all participate in the podcast.

“When I was first in practice, and I didn’t even realize what it was, I just had this feeling of self-doubt. Was I really qualified to do this job? Am I good enough? Am I doing well enough? Am I taking good enough care of my patients?” shared Dr. Collinge. “As I grew the self-confidence to overcome it and feel comfortable in my role and comfortable in the care I was providing to children, it went away.”

The surgeons talk about the challenge of managing their own expectations of themselves, both professionally and personally, while also managing the expectations and perceptions of others.

Connecticut Children’s goal for the podcast series is to open minds and elevate a sense of connection among the healthcare community and beyond. We also hope to inspire you and your peers, we look to encourage medical students to enter the field of surgery and continue discussions around relevant and timely topics.

Hear the Podcast

Return to Play Resources for Your Patients

Some youth sports are resuming in schools and the community, which is good news for athletes. But after months off, returning to play also comes with the risk of injury.

So Connecticut Children’s has launched an online Return to Play Kit for patients and families, filled with expert advice to keep athletes injury-free and at the top of their game.

The kit includes a week-by-week guide to easing back to activity, warning signs of common overuse injuries, and the seven rules of sports injury prevention.

Encourage your patients and families to check it out at connecticutchildrens.org/returntoplay.

Return to Play Kit

ENT Down Syndrome Clinic

March 21 was World Down Syndrome Awareness Day. Connecticut Children’s Down Syndrome Clinic offers the support of pediatric specialists from our otolaryngology, audiology, and speech-language pathology teams.

They are available to evaluate children with Down syndrome (Trisomy 21), who are sometimes affected by ear, nose, and throat problems that require a specialist. The Clinic treats the following conditions:

  • ● Airway disorders
  • ● Conductive hearing impairment
  • ● Difficulty swallowing
  • ● Middle ear fluid
  • ● Obstructive sleep apnea
  • ● Sensorineural hearing impairment
  • ● Speech and voice disorders

Help with rehabilitation related to hearing loss, speech, and swallowing disorders is also available as part of this clinic.

Down Syndrome Clinic

Cardiology Device First in the World

First in the World: Haresh’s Story

Haresh Surti may be young at heart, but at 62 years old, he is no kid. So at first, it might seem unusual that he receives heart care at Connecticut Children’s – known far and wide as the state’s only health system 100% dedicated to children.

The truth is, lots of adults receive care from Connecticut Children’s Heart Center and Adult Congenital Heart Disease Services program. That part of Haresh’s story is not unusual.

But his story is rare for another reason.

In fact, it’s the first in the world.

“What would I be doing in a children’s hospital?”

About two years ago, Haresh’s regular doctor sent him to a cardiologist at an adult health system, wondering why he’d been feeling so run down. The cardiologist discovered a hole in Haresh’s heart – a condition that had existed, undetected, since birth – and two additional heart issues that had developed as a result.

As Haresh was taking this in, the cardiologist told him something else surprising: He was referring Haresh to Connecticut Children’s. Haresh’s first thought was, “What would I be doing in a children’s hospital?”

“He told me that Connecticut Children’s has a wider variety of knowledge about my condition – they’re the experts,” Haresh says. He was referred to the head of Connecticut Children’s Division of Cardiology, Shailendra Upadhyay, MD, CEPS.

And then Connecticut Children’s cardiology team got to work.

“The most high-end, the most technologically advanced”

Because of the numerous issues in his heart, Haresh’s case was complicated. Connecticut Children’s specialists in cardiac intervention, ultrasound, adult congenital heart disease, and pulmonary hypertension worked together to come up with a plan.

“We really support the most high-end, the most technologically advanced medical care for each patient,” says Director of Interventional Cardiology Frederic Bernstein, DO. “We find exactly what the problem requires, and find a way to give patients the best of what they need.”

For Haresh, they started by reviewing all of the existing treatment
options. When they weren’t satisfied with what was available, they looked even further – and found a new model of a device that could close the hole in Haresh’s heart, while still allowing just the right amount of blood flow.

The challenge? While this kind of device – technically, a “Multi-Fenestrated ASD Occluder” – is available in other parts of the world, the FDA hadn’t yet approved it for use in the U.S. And the new model that Connecticut Children’s wanted to use for Haresh hadn’t been used yet anywhere in the world.

Dr. Bernstein began the process of petitioning the FDA for a special clearance. While he waited for an answer, he reached out to the device manufacturer, Lifetech Scientific, to learn everything he could. By the time the FDA issued its approval, Dr. Bernstein and the Lifetech Scientific team were chatting regularly, and Haresh was ready to make history.

“All of the doctors agreed and were on the same page,” says Haresh. “Dr. Bernstein took his time and explained everything. It gave me peace of mind.”

“Care that’s not available anywhere else”

When Haresh’s procedure took place in December 2020, Connecticut Children’s and Haresh became the first in the world to pioneer the newest model of the life-saving device. The device’s manufacturers joined the procedure by Zoom, so Dr. Bernstein could give real-time feedback about their product.

Just two months later, “I can see the difference,” says Haresh. His energy is coming back. He’s feeling better and better every day. “It’s like a miracle,” he says.

Beyond The Pale

This case was prepared by Pediatric Emergency Medicine fellow Owen Kahn, MD.
The patient was referred to the Connecticut Children’s Emergency Department by Carolyn Ganeles, MD.

A 2-month-old male presented to the Connecticut Children’s Emergency Department (ED) limp and in respiratory distress. Earlier that day, he was at his normal, healthy baseline. Approximately four hours prior to arrival to the ED, he vomited once, and was subsequently less active and less interested in feeding. Later, his parents noticed labored breathing and that he was almost limp, so they called their pediatrician who recommended urgent evaluation in the ED. At triage, he was noted to be in respiratory distress and diffusely hypotonic so he was taken to the resuscitation bay as a “medical alert”.

He was born at 37 weeks and 2 days gestation after an uncomplicated pregnancy and delivery. His mother did receive RhoGam as she is O negative and he is A positive. His initial newborn screen had an abnormality that was not detected on repeat screening. He had done well since birth and was tolerating appropriately-mixed formula. There is no significant family history. Two days prior to arrival in the ED, he was seen for his routine two-month health maintenance visit, during which he received multiple standard immunizations.

In the ED, he was ill appearing, lethargic and gray. He had grunting and tachypneic respirations with a RR of 60. He was afebrile and had a normal heart rate but was hypotensive at 48/33. His sclerae were icteric and mucous membranes were dry. His lungs were clear and his abdominal exam was benign. He was diffusely hypotonic. There were no signs of injury on exam. Peripheral IV access was acquired and he was given a 20 mL/kg normal saline bolus with good effect on his blood pressure. He was rapidly started on high-flow oxygen by nasal cannula. Point of care studies showed his hematocrit was <15 and hemoglobin was undetectable; normal Na 140, K elevated to 6.2, glucose 172, ionized calcium 1.43; venous pH < 7, pCO2 21, pO2 49 and HCO3 undetectable. His blood appeared thin and watery. There was concern for possible dilution from the normal saline bolus so an arterial stick was done at a different site yielding similar-appearing blood with similar lab results. Formal labs showed similar results to iSTAT, including hemoglobin 2.5, hematocrit 9.5, WBC 37K with 33% neutrophils, platelets 537, MCV 120, RDW 20.1, retic % 17%, HCO3 less than 2, BUN 24, Cr 0.6, Mg 3.9, Phos 11.7, AST 90 but ALT 28, LDH elevated at 821, Total bilirubin 4.9, INR 1.3 (PT 14.8, PTT 56). Chest X-ray showed hyperaerated lungs but no focal pathology. He was given multiple aliquots of packed red blood cells as well as empiric antibiotics. His respiratory status did not improve with high-flow nasal cannula, so anesthesia was consulted for rapid sequence intubation which was successful. He was then admitted to the PICU for ongoing management. After the smear was reviewed by Hematopathlogy, the team was notified about the concern for Donath Landsteiner Hemolytic Anemia.

In the PICU, the massive transfusion protocol was initiated. Per Hematology recommendations for presumed Donath-Landsteiner hemolytic anemia, he was started on systemic steroids and later received multiple doses of IVIG. His overall clinical status stabilized and improved. He was able to be extubated but had ongoing hemolysis requiring continued blood transfusions throughout his admission. Testing for Donath Landsteiner antibody, G6PD and ADAMTS13 were all negative. Per Hematopathology, the Donath Landsteiner test is technically difficult to perform; a negative test does not rule out the disease. During his admission he was noted to have increased right upper extremity tone, however, an MRI of the brain did not reveal any focal lesions. He was discharged home and follows with Hematology, Neurology, Physical Therapy, Occupational Therapy and Birth-to-Three.

Donath-Landsteiner hemolytic anemia, or paroxysmal cold hemoglobinuria (PCH) is an acquired autoimmune hemolytic anemia. PCH is exceedingly rare and accounts for less than 1% of all autoimmune hemolytic anemias. It is characterized by development of an autoantibody that targets the P-antigen on red blood cells in cold temperatures, usually while the blood is in our relatively cool extremities, which later leads to hemolysis upon re-warming in our cores. It usually occurs in the setting of an infection, autoimmune disorder or neoplasm. In children, the trigger is often a viral infection such as varicella, measles, mumps, EBV, CMV, adenovirus, RSV, influenza and even the measles vaccine. It can occur with other infections including Mycoplasma, Klebsiella, E. coli, H. influenza and classically, syphilis.


Göttsche B, Salama A, Mueller-Eckhardt C. Donath-Landsteiner autoimmune hemolytic anemia in children. A study of 22 cases. Vox Sang. 1990;58(4):281-286.
Barcellini W. Immune hemolysis: diagnosis and treatment recommendations. Semin Hematol. 2015;52(4):304-312.

Surgical Options for Difficult Seizure Patients

By: Markus Bookland, MD, Division of Emergency Medicine

Patients with the most severe forms of epilepsy can be hobbled by their seizures–unable to participate in school, unable to get work, unable to enjoy time with their families. Surgical resection of a damaged portion of the brain generating the seizures can provide life-changing relief from epilepsy for some children. But, what can we do for children where an entire hemisphere of the brain is damaged and causing the child to seize?

In these challenging patients, hemispherotomy can be a path to long sought seizure control. This neurosurgical procedure disconnects the damaged, seizure-generating cerebral hemisphere from the healthy hemisphere, “isolating” the patient’s epileptic discharges safely away from their functional cerebral centers.

Connecticut Children’s Division of Neurosurgery recently offered this procedure to a young girl who had been suffering recurrent seizures since she was a newborn. As a newborn, she experienced a perinatal stroke in one hemisphere of her brain; and, while her nervous system had largely relocated most of her motor and language function to her healthy hemisphere, she experienced recurrent seizures emanating from the damaged hemisphere. Increasing amounts of medication were having little impact on her seizures and the side effects were becoming more difficult to tolerate.

Dr. Jennifer Madan-Cohen, epileptologist at Connecticut Children’s, recommended the family consider a hemispherotomy to disconnect the seizing damaged hemisphere from the patient’s healthy hemisphere; and they elected to try this bold  intervention.

The patient underwent surgical disconnection of her cerebral hemispheres and was discharged from the hospital two weeks later. While she had been having near daily seizures prior to surgery, since leaving the hospital she has not had a single seizure, and Dr. Madan-Cohen is considering weaning down her anti-seizure medications.

We are thrilled to offer surgical solutions, like hemispherotomy, for our epilepsy patients who cannot find a meaningful quality of life with medication alone.

Welcome Aboard!

Join us in welcoming new additions to our medical staff!

James Enos, MD

Pediatric Cardiology

  • MD, Alpert Medical School, Brown University, 2011
  • Pediatrics, New York Presbyterian Hospital, 2014
  • Pediatric Cardiology, Children’s National Health System, 2017

Alison Sturm, MD

Pediatric Emergency Medicine

  • MD, Medical College of Georgia, 2003
  • Pediatrics, University of Maryland Hospital for Children, 2006
  • Pediatric Chief Resident, University of Connecticut
  • Pediatric Hematology/Oncology Fellowship, University of Michigan

Hanan Kamal Tawadrous, MD

Pediatric Nephrology

  • MD, Ain Shams University Hospital, 1990
  • Ain Shams University, Internship, Internal Medicine, 1992
  • Ministry of Health, Cairo, Egypt, Internal Medicine, 2002
  • Rutgers New Jersey Medical School, Pediatrics, 2007
  • Fellowship, SUNY Health Science Center at Brooklyn, Pediatric Nephrology, 2010

Anna Tsirka, MD

Director, Cardiomyopathy Services

Pediatric Cardiology

  • MD, National Capodistrian University of Athens
  • Pediatrics, Stony Brook University Hospital, 1997
  • Neonatology, Magee Women’s and Children’s Hospital, 1998
  • Pediatric Cardiology, St. Louis Children’s Hospital, 2001

Continuing Medical Education (CME) Updates

For all CME events, stay up to date by visiting our calendar at cccme.eeds.com

View Full CME Calendar

2020-2021 VIRTUAL INTERACTIVE WORKSHOP SERIES

ZOOM URLs to be provided upon registration 

Date: Wednesday, May 5, 2021 • 9 am-4:00 pm
Title: Decolonizing Global Health

Date: Friday, May 21, 2021 • 8:30 am-4:00 pm
Title: Advanced Practice Provider Summit 2021: Keeping Kids Safe


PEDIATRIC GRAND ROUNDS 

Virtual via ZOOM. Podcast also available.

When: Tuesdays between 9.1.20 – 6.30.21, 8am-9am

Visit our Eeds Portal- Live Calendar ▶


ASK the EXPERTS 

Virtual via ZOOM. Also available on-demand.

When: Fridays as needed, 8am-9am

Visit our Eeds Portal- Live Calendar ▶


VIRTUAL EVENING LECTURE SERIES

Date: April 20, 2021 • 6:30pm – 8:00pm
Title: Helping Children with Learning Attentional and other Developmental Disorders/Understanding Educational/Neuropsychological Evaluations and How Students Qualify for Intervention Services at School


For all CME events, stay up to date by visiting our calendar at cccme.eeds.com
Please feel free to email our office with any questions at cme@connecticutchildrens.org.

Visit our Eeds Portal

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