The new building of the Morgan Stanley Children's Hospital of NewYork-Presbyterian, at the corner of 165th Street and Broadway, opens officially on Nov. 12. The $120 million, 10-story structure gives pediatric researchers and healthcare specialists more space in which to study pediatric health problems and to provide the latest diagnostic and treatment techniques. The new site also supplies enough room for young patients and their families to be together during the child's stay, in the patient room, playroom, family support lounge or classroom on each of the patient-care floors.
The building adds 233,000 square feet of space to the existing hospital, including one floor of pediatric basic science research labs to foster collaborations between researchers and clinical faculty, says Dr. John Driscoll, Reuben S. Carpentier Professor and Chairman, Department of Pediatrics at P&S and physician-in-chief of the pediatrics service at Morgan Stanley Children's Hospital. Other features include 100 medical and surgical beds, 41 pediatric intensive care unit beds, and 50 beds for infants in the neonatal intensive care unit. The patient rooms each have a daybed for parents and storage space for long-term stays.
"We brought together over 250 physicians, nurses, support staff, and family members to help design a new hospital to support medical advances while minimizing the anxiety levels of children and their parents," Dr. Driscoll says. Babies Hospital, founded in 1887, is the only children's hospital in Manhattan. Morgan Stanley employees started the building campaign with a $55 million donation. After a planning stage of two years, construction began less than three years ago.
Following are profiles of just a few of the researchers and clinicians who have given the hospital its world-renowned reputation.
Two asthma education programs developed by Columbia pediatric and public health researchers, which started as small, local projects to help inner city children, are now helping children across the United States and potentially worldwide to better manage the condition.
Dr. Robert Mellins, professor of pediatrics at P&S, and Dr. David Evans, professor of clinical sociomedical sciences at the Mailman School of Public Health, and their colleagues developed "Creating a Medical Home for Asthma," in collaboration with the New York City Department of Health and Mental Hygiene (DOHMH) about a decade ago when the health department saw that the incidence of asthma was rising in low-income neighborhoods served by their child health clinics. The program's goal was to teach clinic staff and administrators to provide state-of-the-art asthma care and education to the children and their families so the children would have fewer asthma attacks and make fewer trips to an emergency room. The result: improved identification and treatment, improved patient education, and reduced emergency department visits.
That program has been so successful that the Centers for Disease Control and Prevention (CDC) is working with Columbia and DOHMH to make it available on the DOHMH web site.
"Based on our results with the clinics, the CDC approached us with the idea of turning what we did into a web-based program so anybody in the world could jump start such a program. The site even includes instructional videos for physicians, nurses, and students," Dr. Mellins says.
The other program, "Open Airways For Schools," is geared to children diagnosed with asthma in grades three to five. The children get six 40-minute lessons on ways to control their asthma.
Developed and evaluated in 12 New York City schools in the mid 1980s, the Open Airways program has reached about 30,000 children in New York and more than 200,000 nationwide. It is delivered through a partnership of the American Lung Association of the City of New York, the New York City Department of Health and Mental Hygiene, the New York City Department of Education, GlaxoSmithKline, and the New York City Council. So far, more than 1,400 school nurses and public health educators in New York have been trained to teach the curriculum.
The American Lung Association is spearheading the drive to bring the program now in more than 20,000 elementary schools to all 67,000 elementary schools in the country. A recent evaluation of children in the program found they were absent about two fewer days per year. The researchers also found that homework assignments intended to educate parents by educating children also have been successful.
"The program taught kids to recognize their own symptoms and talk to a teacher or parent or take their quick reliever medication. We also found that the kids are teaching their parents about their condition, which helps them manage their asthma better," Dr. Evans says.
One of the most pressing pediatric health problems in the United States today is the increase in the incidence and severity of Type 2 diabetes in children, says Dr. Rudolph Leibel, professor of pediatrics and medicine and co-director of Columbia's Naomi Berrie Diabetes Center. Genetic predisposition coupled with rising childhood obesity rates is resulting in younger children developing Type 2 diabetes, formerly known as "adult-onset" diabetes because it was rarely seen in children.
"We've had 8-year-olds come to the Berrie Diabetes Center clinic with Type 2 diabetes," Dr. Leibel says. "It's clear that obesity is stressing the genes that predispose someone toward diabetes. The kids with earliest onset are likely to have the greatest genetic predisposition to the disease."
Columbia and Morgan Stanley Children's Hospital are studying the problem in lab animals and people, using basic science, experimental, and clinical research approaches to better understand the genetic predisposition to obesity and diabetes. The research ranges from cloning genes responsible for obesity in mice to applying what is known about the genetics of mouse forms of Type 2 diabetes to children.
The Diabetes and Endocrinology Research Center, an NIH-funded center established at Columbia earlier this year, and the Russell Berrie Foundation Program in Cellular Therapies for Diabetes are providing core facilities for Berrie Center faculty and supporting diabetes research.
"The human body is built to store excess calories as fat to aid survival when food is scarce," Dr. Leibel says. "But that mechanism can do harm when food is abundant and physical activity is low." The problem is especially severe among African-American and Hispanic children the majority of the child population in northern Manhattan. Ten to 15 years ago, only a small percentage of new-onset childhood diabetes cases at the medical center were Type 2; now, they make up 35 percent of new cases here. The increased susceptibility to diabetes in these groups appears to be genetic.
Dr. Leibel warns that the risk of diabetes complications in these children is equal to or greater than in adults, so that if inadequately treated, these children will experience kidney and heart disease, impaired vision, and circulation problems as young adults.
"We want ultimately to prevent both obesity and diabetes but in the meantime, we're looking at ways to treat both conditions more effectively. If we could better manage obesity in children, we could greatly reduce diabetes in both children and adults," Dr. Leibel says.
In a program begun last October, every baby born in New York state is now tested for cystic fibrosis. At the Cystic Fibrosis Center at Columbia, this new screening is seen as an exciting chance to make an even bigger difference in young patients' lives.
"Newborn screening gives us a window of opportunity we didn't have before," says Dr. Lynne Quittell, associate clinical professor of pediatrics and medicine and director of the Cystic Fibrosis Center.
Before screening began, doctors usually didn't see children until they began showing signs of the disease around age 2 or 3. By then, Pseudomonas aeruginosa the bacterial villain in cystic fibrosis that eventually leads to the lung's destruction has already colonized a child's lungs and nutritional problems have slowed growth.
With the newborn screening, doctors can intervene earlier with nutritional supplements and may be able to delay the bacterial colonization of the lungs. "It's not totally clear what the outcomes will be," Dr. Quittell says, "but what's great about the early testing is that we will learn whether it makes a difference or not." The screening program should also give basic researchers a better idea of how lung disease progresses. Scientists have proposed several different hypotheses to explain how lung disease begins, but none has emerged as a leading theory.
Other changes at the Cystic Fibrosis Center also hold promise for improving patients' lives. "There's a big push for better infection control now. We want to be careful that patients don't pass infectious organisms to each other in clinical settings," Dr. Quittell says. "We're really excited about the improvement in infection control at Morgan Stanley Children's Hospital our patients will have their own rooms."
The center is also collaborating with the Cystic Fibrosis Foundation on a large quality improvement program to try to lengthen patients' lives. "If we systemize how we provide healthcare so each practitioner isn't doing things differently, we could increase survival by seven years, even without any new therapies," Dr. Quittell says. The Columbia center is one of the first 10 centers to enroll in the program, which will eventually extend to all 117 centers in the country.
Columbia's Cystic Fibrosis Center, one of the country's oldest, has made great strides in the past 50 years in understanding and treating the disease. In 1938, Dr. Dorothy Andersen recognized that seemingly unrelated lung infections and digestive problems were manifestations of the same disease, which she named cystic fibrosis of the pancreas. In the 1950s, Dr. Paul Di Sant'Agnese discovered that cystic fibrosis patients produced an unusually salty sweat, and developed the simple sweat test, still the standard diagnostic tool. This year, Dr. Lisa Saiman, professor of clinical pediatrics, discovered that an oral antibiotic, azithromycin, commonly used to treat children's ear infections, also dramatically improves lung function in cystic fibrosis (see In Vivo Vol. 2 No. 17).
"Researchers and clinicians communicate and collaborate very closely here," Dr. Quittell says. "That interface helps us provide the most comprehensive care possible for this difficult disease."
Hours after Chloe Scotson was born, her pediatrician listened to her heart and heard a murmur. Though murmurs are common in newborns, an echocardiogram confirmed Chloe had three potentially fatal heart defects a hole in the wall of her heart that separates the two ventricles, a too-narrow aorta that restricted blood flow to the rest of the body, and a small outflow tract of the left ventricle to the aorta.
Chloe's parents, Rick and Elizabeth, scrambled to find the best medical help for their child, and three days later she was whisked to the pediatric cardiology unit of Morgan Stanley Children's Hospital for open heart surgery.
"It's incredible that they can send a 6-day-old baby home a week after heart surgery with instructions for normal newborn care,'" Elizabeth Scotson said a few days after the surgery when Chloe was moved out of critical care.
"No baby is too young for heart surgery these days," says Dr. Welton Gersony, the Nadas Professor of Pediatric Cardiology and director of the Pediatric Cardiology Center at NewYork-Presbyterian. The high volume of surgeries on infants since the 1980s has been made possible by improvements in the precision of the pre-op diagnosis, the miniaturization of equipment, including the heart-lung machine, surgical skill, and postoperative care.
Advances in less invasive catheterization technologies also mean that many babies with heart defects don't even need surgery. "Every situation has ratcheted up a notch," Dr. Gersony says. "The patient who was once inoperable is now eligible for a transplant. For the more complex patients like Chloe, operations are available to correct situations we previously couldn't treat. And less complex cases may not even need surgery." Instead, by threading a catheter through an artery and into the heart, a balloon attached to the catheter can widen a narrow valve, or stents can widen arteries or veins.
The increase in the number of interventional procedures done by the catheterization lab more than makes up for the drop seen in diagnostic procedures, Dr. Gersony says. Imaging techniques are now diagnosing problems where angiograms using catheters were once needed. "When echocardiography started about 20 years ago, it wasn't trustworthy enough to rely on," he says. "But in the past two years it's become so important that most patients don't need diagnostic catheterization." Recently, MRI has been added to the cardiologist's armamentarium, and the boundaries of echocardiography have been stretched so doctors can now diagnose heart defects in utero as early as 14 weeks into the pregnancy.
"Pediatric cardiology is a wonderful example of a multidisciplinary program," Dr. Gersony says. "We have critical care specialists, cardiologists, surgeons, anesthesiologists, critical care nurses, and respiratory therapists. It requires a lot of man- and woman-power in all these areas to be successful, and I think we are. The patients prove it by coming here from all over the world."