Riley Children's Health Annual Report 2022 – 2023

Riley Children's Health is a nationally ranked pediatric health system that uses expertise, innovation and the latest advancements to deliver the highest level of patient care to children and families in Indiana and across the nation.


WELCOME TO RILEY CHILDREN’S HEALTH Founded in 1924, Riley Children’s Health will soon celebrate a century of delivering preeminent care to children. Through the years, we’ve developed a keen understanding of what it takes to be a leader in pediatric healthcare—provision of advanced treatments, engagement in research, and a commitment to provide compassionate, patient- and family-centered care. We take these expectations seriously and are honored that Riley Children’s is consistently among the nation’s leading children’s hospitals. This year, 10 out of 10 of our specialties are ranked by U.S. News & World Report , with our Urology and Pulmonology programs ranked third and eighth in their fields, respectively. Our ability to offer the latest treatments and clinical trials is enhanced by our partnership with Indiana University School of Medicine. At the forefront of novel research in many pediatric specialties, the IU School of Medicine Department of Pediatrics is ranked seventh in National Institutes of Health-funded research. Riley Children’s is among an elite group of hospitals to have earned Magnet® status from the American Nurses Credentialing Center. We are also a destination for leading- edge maternity and newborn healthcare with our new Maternity Tower and a comprehensive Fetal Center that includes a growing fetal surgery program. Our achievements in patient care and clinical innovation would not be possible without our dedicated One Team— physicians, researchers, advanced practice providers, nurses and other care team members come to work each day with one goal in mind—to improve the health of children. We invite you to learn more about our pediatric health system and the many ways Riley Children’s is making a difference for the patients and families we serve.

Table of contents Welcome to Riley Children’s Health About Riley Children’s Health Proud to be a nationally ranked children’s hospital Nursing at Riley Children’s Health


> Riley Children’s Health: Ranked 7th in National Institutes of Health-funded pediatric research. > Cardiology: Coarctation of the aorta study funded by Department of Defense Discovery Award. > Diabetes and Endocrinology: Researchers celebrate approval of new drug for Type 1 diabetes. > Nephrology: Research team aims to design a neonatal peritoneal dialysis catheter for use in low- and middle-income countries. > Maternal Fetal Medicine: Indiana’s first fetal intervention surgery performed for twin-to-twin transfusion syndrome. > Neonatology: Team leads site for A-Plus study focusing on risk of postpartum sepsis and death. > Gastroenterology, Hepatology and Nutrition: Riley Children’s one of the few U.S. hospitals to offer a comprehensive program for children with intestinal failure. > Riley Children’s Health: Multispecialty team among the few worldwide to treat an infant with sirenomelia. > Neonatology: Riley Children’s offers the first comprehensive Perinatal Genomics Program for critically ill newborns. > Pulmonology: Riley Children’s leads $12 million P01 from the National Heart, Lung and Blood Institute. > Urology: First goals of care platform developed for children with spina bifida.

Pediatric specialties Adolescent Medicine Allergy and Immunology Anesthesiology Cardiology Cardiothoracic Surgery Child Protection

Critical Care: Cardiac Critical Care Critical Care: Pediatric Critical Care Dentistry Dermatology Developmental Medicine Diabetes and Endocrinology

RILEY CHILDREN’S HEALTH LEADERSHIP TEAM Ryan Nagy, MD Interim President D. Wade Clapp, MD Chair, Department of Pediatrics, IU School of Medicine Elaine G. Cox, MD Chief Physician Executive John Harding Chief Operating Officer Megan Isley, DNP, MSN, RN Chief Nursing Officer Tyler Leishman

Diagnostic Radiology Emergency Medicine Gastroenterology, Hepatology and Nutrition General Pediatrics Hematology/Oncology Hospital Medicine Infectious Diseases Interventional Cardiology and Electrophysiology Interventional Radiology Maternal Fetal Medicine Medical and Molecular Genetics Neonatology Nephrology Neurology Neuroradiology Neurosurgery Ophthalmology Orthopedic Surgery Otolaryngology – Head & Neck Surgery Palliative Care Pediatric Surgery Physical Medicine and Rehabilitation Plastic Surgery Primary Care Psychiatry and Psychology Pulmonology and Sleep Medicine Rheumatology Transplant Surgery Trauma Services Urology Riley Children’s Health team member directory Refer a patient

Chief Strategy Officer Mara E. Nitu, MD Chief Medical Officer Mark Cain, MD, FAAP

Surgeon-in-Chief Frank Runion Chief Financial Officer Emily C. Webber, MD Chief Medical Information Officer

Mara E. Nitu, MD Chief Medical Officer, Riley Children’s Health

Riley Children’s Health, Indiana’s largest and most skilled pediatric health system, provides nationally ranked care in 18 communities across the state. Children’s Surgery Verification ABOUT RILEY CHILDREN’S HEALTH

By the numbers A look at patient care in 2022


475 BEDS



Home to Indiana’s only Level I Pediatric Trauma Center verified by the American College of Surgeons (ACS)



Verified by ACS as a Level I Children’s Surgery Center

Designated a Platinum Center of Excellence by the Extracorporeal Life Support Organization

Riley Children’s has earned Magnet®status, recognizing excellence in nursing care.



Leader in research and innovation

■ Seventh-ranked children’s hospital in the nation for research funding ■ One of the largest pediatric research hospitals in the Midwest ■ Home to the Herman B Wells Center for Pediatric Research , the Children’s Clinical Research Center and the Center for Children’s Health Services Research

■ One of the largest medical schools in the U.S. ■ One of the busiest locations for pediatric research funded by the National Institutes of Health and other sponsors Riley Children’s Health and IU School of Medicine are committed to providing excellent healthcare for children through prominence in education, training and research.







Annual Report 2022 – 2023

PROUD TO BE A NATIONALLY RANKED CHILDREN’S HOSPITAL Riley Children’s Health is ranked among the top children’s hospitals in the nation by U.S. News & World Report . In 2023–2024, we are ranked in 10 out of 10 pediatric specialties and also ranked third * in the Midwest. See below for some program distinctions that contribute to our standing as a leader in pediatric healthcare. (See the specialty sections in this report for more details.)

“R iley’s consistency in being ranked by U.S. News & World Report reaffirms that our team members are committed to providing the best care. We are grateful for the compassion and expertise our clinicians continue to offer to patients and their families. We thank our patients and their families for trusting us with their care.” – Mara E. Nitu, MD Chief Medical Officer, Riley Children’s Health Professor of Clinical Pediatrics, IU School of Medicine > Connect with Dr. Nitu on Doximity.





■ Early access to clinical trials, novel cancer therapies and research through the Children’s Oncology Group Phase I and Pilot Consortium and the Pacific Pediatric Neuro-Oncology Consortium ■ One of the few pediatric cancer programs in the region to offer pediatric stem cell transplant and CAR-T cell therapy programs Larry W. Markham, MD, FAAP, FACC | Mark W. Turrentine, MD DIVISION CHIEF, CARDIOLOGY DIVISION CHIEF, CARDIOTHORACIC SURGERY ■ National leader in patient outcomes with mortality rates below benchmark** ■ One of the few programs in the nation capable of implanting total artificial hearts in children

■ 12th pediatric center in the nation to launch aquapheresis, allowing for continuous renal replacement therapy in smaller patients, including neonates ■ Offers ambulatory blood pressure monitoring for patients with asymptomatic elevated blood pressure; completes more than 500 24-hour ambulatory blood pressure monitor readings annually Laurie L. Ackerman, MD, FAANS, FAAP | Christopher T. Jackman, MD INTERIM DIVISION CHIEF, NEUROSURGERY DIVISION CHIEF, NEUROLOGY ■ Indiana’s only laser interstitial thermal therapy program for epilepsy and neuro-oncology; only precision genomics program for neuro-oncology ■ Accredited by the National Association of Epilepsy Centers as a Level 4 Comprehensive Epilepsy Center Christine B. Caltoum, MD DIVISION CHIEF ■ Use of O-arm with navigated placement of pedicle screws in scoliosis surgery and for treatment of hip dysplasia ■ Gait lab analysis used in planning for corrections of complex deformities James F. Chmiel, MD, MPH, ATSF DIVISION CHIEF ■ One of the largest cystic fibrosis programs in the nation; only program in Indiana accredited by the Cystic Fibrosis Foundation ■ Home to the nation’s only multidisciplinary program for patients with Alström syndrome Rosalia Misseri, MD DIVISION CHIEF ■ One of seven Congenital Adrenal Hyperplasia Comprehensive Care Centers in the U.S. (designated by the CARES Foundation) ■ One of 10 bladder exstrophy centers of excellence in the nation (designated by the Association for the Bladder Exstrophy Community)

Cardiology & Heart Surgery

Neurology & Neurosurgery

Diabetes & Endocrinology



■ Only comprehensive care center in the Midwest for congenital adrenal hyperplasia ■ Active in clinical and translational research studies for diabetes and endocrine disorders

Gastroenterology & GI Surgery

Jean P. Molleston, MD DIVISION CHIEF

Pulmonology & Lung Surgery

■ Home to leading multidisciplinary programs for intestinal rehabilitation, eosinophilic disorders, IBD, motility and aerodigestive disorders, and weight management ■ Pediatric psychology program dedicated to treat psychological conditions related to GI disease Laura S. Haneline, MD DIVISION CHIEF ■ Innovative heart center NICU with complete integration and daily team rounding of neonatologists with CV intensivists and cardiologists that contribute to stellar outcomes ■ Excellent outcomes attributed to experience managing a consistently high volume of complex patients and neonatal expertise within all subspecialties at Riley Children’s





* Riley Children’s Health is tied with three other children’s hospitals in the Midwest for third in the rankings . ** Source: The Society of Thoracic Surgeons (STS) Table 16, Harvest Report, published January 2023 for period ending June 30, 2022

Annual Report 2022 – 2023


Specialized nursing practices


Clinical nurses


Bachelor of Science in Nursing 83%

Associate of Science in Nursing 9%

■ Indiana’s first obstetrical intensive care unit (OBICU), opened at Riley Children’s in

■ Dedicated team of cardiology-trained nurses cares for patients in the Riley Heart Center cardiovascular intensive care unit and step-down units.

■ Specially trained nurses in the Riley Burn Center care for children from their first visit through recovery after surgery.


2021, innovates the way nurses care for maternal patients. In our model, OBICU nurses are dually trained and competent in critical care and obstetric nursing.

Certified RNs 38%

Graduate Degrees 8%

Advances in Neonatal Care: April 2022 Inclusivity and Respect: Beyond Personal Pronouns Journal of Neonatal Nursing: August 2022 Eat, Sleep, Console Method and the Management of Neonatal Opioid Withdrawal Syndrome: A Literature Review Journal for Specialists in Pediatric Nursing: August 2022 Evaluation of a Nausea Assessment Tool in the Pediatric Oncology Population Journal for Nurses in Professional

Program distinctions

■ Magnet®designated (2004, 2009, 2014, 2019); only 10% of U.S. hospitals Magnet designated


■ Only Entry-to-Practice Nurse Residency Program in Indiana accredited by the Commission on Collegiate Nursing Education; accreditation received in 2022

Nurses at Riley Children’s are engaged in research related to: ■ Pediatric nurses’ perspectives on suicide screening and prevention ■ Pediatric palliative care education and its impact on nursing awareness and perception of pediatric palliative care ■ Lived experiences of caring for an infant with cleft palate ■ Food insecurity

Development: May/June 2022 Elevating the Preceptor Role: Implementation of a New Model for Orientation

Annual Report 2022 – 2023

The Indiana University School of Medicine Department of Pediatrics and Riley Children’s Health are ranked seventh in National Institutes of Health (NIH)-funded pediatric research in federal fiscal year 2022. The department received more than $38 million in NIH grants for 76 studies. Read highlights of research in severe asthma, childhood cancers and heart disease. PIONEERS >

The Herman B Wells Center for Pediatric Research at IU School of Medicine works to find new technologies and treatment options for children and is nationally recognized for life-sustaining innovations.

Pediatric endocrinologist Jamie L. Felton, MD, is a physician scientist in the Herman B Wells Center for Pediatric Research.

The adolescent medicine specialists at Riley Children’s Health treat a wide variety of adolescent health issues, including reproductive health, eating disorders and gender health. Our fellowship-trained physicians routinely work with specialists in cardiology, hematology/oncology, child development, psychiatry, endocrinology, and obstetrics and gynecology to provide patient-centered, comprehensive care for young people up to age 21. ADOLESCENT MEDICINE


Riley adolescent medicine specialists lead research in multiple areas: ■ Human papillomavirus (HPV) ■ HPV vaccines 12 new research grants in 2022

■ Sexually transmitted infections ■ Healthcare access for youth

DIVISION CHIEF Rachel A. Katzenellenbogen, MD Professor of Pediatrics, IU School of Medicine > Connect with Dr. Katzenellenbogen on Doximity. >

Program distinctions

Our program is committed to advocating for families of adolescents and young adults in Indiana and across the nation, with the goal of improving their health and wellness.

■ Eating disorders ■ Teen pregnancy prevention ■ Gender health ■ Long-term effects of illness and recovery on youth

■ One of the largest divisions of its kind in the nation with high-volume clinical care, prolific grant-funded research and a robust training program ■ One of only nine nationally recognized Leadership Education in Adolescent Health (LEAH) programs; provides interdisciplinary training in the needs of adolescent and marginalized populations New designation in 2022

9 board certified physicians


See full team member list

■ Home to the Charis Center, Indiana’s most comprehensive eating disorders treatment program

■ One of the few programs regionally that serves the unique needs of gender-diverse patients and their families

Our physicians lead subspecialty training through a three-year Adolescent Medicine Fellowship. Fellows provide clinical care, conduct research, direct resident education and can earn a master’s degree in public health.

NOTABLE PUBLICATIONS Journal of Criminal Justice: December 2022 Mental Health Outcomes from Direct and Indirect Exposure to Firearm Violence: A Cohort Study of Nonfatal Shooting Survivors and Family Members

Specialized programs

Adolescent Medicine Consultation Program We offer evaluation and treatment for any adolescent health issue requiring more specialized treatment than is typical for primary care. Common referrals include: ■ Mental health and behavioral issues, including anxiety and depression and disordered attention ■ Nutritional concerns, including eating disorders ■ Co-management of chronic illness ■ Evaluation for chronic symptoms that lack a diagnosis

Adolescent Gynecology and Reproductive Health Our physicians evaluate and treat a variety of gynecological conditions, including delayed puberty, abnormal uterine bleeding, polycystic ovary syndrome, chronic pelvic pain and dysmenorrhea. We offer specialized gynecology and reproductive healthcare, including long-acting reversible contraceptive options. Our specialists have extensive experience consulting patients and families about fertility preservation in complex illness, including heart transplants and congenital heart conditions, childhood cancer, cystic fibrosis, and sickle cell disease.

Charis Center for Eating Disorders The Charis Center provides multidisciplinary

The center provides medical, psychological, group therapy, nutritional and parental support

medical, psychological and family services for patients with eating disorders. Inpatient and

through more than 10,000 outpatient visits each year.

outpatient treatment options are offered. Riley Gender Health Program Our interdisciplinary program delivers comprehensive support to patients and their families who are experiencing gender dysphoria and seek supportive, holistic and affirmative care.

PEC Innovation: December 2022 A Human-Centered Designed Outreach Strategy for a Youth Contraception Navigator Program

65 research publications in 2022

Refer a patient online

Annual Report 2022 – 2023


Board certified allergy and immunology specialists at Riley Children’s Health are expertly trained in the management and treatment of pediatric allergy, asthma and immunology issues. Our physicians offer the latest diagnostic methods and treatments delivered in a safe and comfortable manner to children dealing with the challenges of allergic conditions. ALLERGY AND IMMUNOLOGY


■ Riley Children’s participates in five clinical trials and multiple studies investigating the role of the airway microbiome in the development of allergic disease. ■ Our program participates in PARK (Preventing Asthma in High Risk Kids), a multicenter clinical study led by the National Institute of Allergy and Infectious Diseases to investigate the impact of omalizumab to prevent severe asthma and new allergies in preschool-age children. ■ Riley Children’s is one of the leading U.S. sites involved in the study of a proprietary probiotic to prevent the development of allergic conditions in infants. ■ Riley allergy and immunology specialists study the role of food deserts on outcomes of children with asthma.

Program distinctions

Specialized programs Gastrointestinal Eosinophilic Digestive Diseases Program Our multidisciplinary program allows children to see a pediatric allergist, gastroenterologist and dietitian during the same visit. Immunogenetics Program Children with complex immune disorders receive the latest guidance from an immunologist, a geneticist and a genetic counselor. High-Risk Asthma Program This collaborative program addresses the medical and social needs of children and families with severe asthma. Immunohematology Program Pediatric immunologists and hematologists at Riley Children’s provide expertise in managing conditions for children with autoimmune cell defects.

DIRECTOR Girish V. Vitalpur, MD, FAAP, FAAAAI Associate Professor of Clinical Pediatrics, IU School of Medicine > Connect with Dr. Vitalpur on Doximity. 5 board certified physicians See full team member list >


■ Recognized for distinction in clinical care by Food Allergy Research and Education (FARE); performs more food challenges than any other program in Indiana ■ Member of the Jeffrey Modell Centers Network for treatment and research related to primary immunodeficiency diseases


■ Indiana’s only multidisciplinary program for eosinophilic gastrointestinal diseases

The New England Journal of Medicine: May 2023 Phase 3 Trial of Epicutaneous Immunotherapy in Toddlers with Peanut Allergy The Journal of Allergy and Immunology: In Practice: September 2022 The Microbiome as a Gateway to Prevention of Allergic Disease Development

■ Partners with the Indiana Department of Health to analyze all abnormal newborn screenings for severe combined immune deficiencies (SCIDs)

Our team’s inpatient penicillin allergy de-labeling protocol is used in hospitals across the state.

Professional organization affiliations American Academy of Pediatrics – Section on Allergy and Immunology Girish V. Vitalpur, MD, FAAP, FAAAAI American Academy of Allergy, Asthma & Immunology Jay J. Jin, MD, PhD

Annals of Allergy, Asthma & Immunology: August 2022

Food Challenges Conducted: 2019 – 2022

New Patient Volume: 2020 – 2022

Increased Health Care Use in Patients with Moderate-to-Severe Asthma Due to Frequent Preferred Medication Changes The Journal of Allergy and Clinical Immunology: February 2022 The Precision Interventions for Severe and/or Exacerbation-Prone (PrecISE) Asthma Network: An Overview of Network Organization, Procedures and Interventions










Kirsten M. Kloepfer, MD, MS Nurcicek Padem, MD, MS Craig D. Sewell, DO Girish V. Vitalpur, MD, FAAP, FAAAAI Clinical Immunology Society Jay J. Jin, MD, PhD Nurcicek Padem, MD, MS











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Annual Report 2022 – 2023


The expert anesthesiologists at Riley Children’s Health deliver safe, evidence-based and compassionate care to pediatric patients in all areas of anesthesia, perioperative medicine, and acute and chronic pain management. In addition, our specialists are committed to leading innovative perioperative care research, providing high-quality clinical education and improving health outcomes. ANESTHESIOLOGY


Grants are currently funding research related to: ■ Improving safety and efficacy of methadone in children undergoing major surgery ■ Translating science into clinical practice to improve safety and efficacy of opioids in neonates, children and nursing mothers ■ Bedside prediction of opioid-induced respiratory depression in children with pupillometry ■ Pharmacogenetics of oxycodone, personalized care and persistent surgical pain FIT Teens for Juvenile Fibromyalgia Riley Children’s is participating in this multisite clinical trial funded by the National Institutes of Health and the National Institute of Arthritis and Musculoskeletal and Skin Diseases. Committed to quality and safety Riley anesthesiology team members are involved in efforts to improve opioid use safety for pediatric patients. As part of a systemwide stewardship committee at IU Health, our acute pain management team revised the pediatric ambulatory surgery postprocedure order set, which was used 28,000 times across IU Health facilities statewide in 2022. The revisions further improve the safety of opioid and benzodiazepine prescribing in the health system.

Program distinctions

DIVISION CHIEF Rania K. Abbasi, MD, FASA Associate Professor of Clinical Anesthesia, IU School of Medicine > Connect with Dr. Abbasi on Doximity. >

■ Subspecialty anesthesia care for complex cardiac, neurosurgical and transplant surgeries, as well as acute and chronic pain management services

35 board certified physicians


See full team member list

■ Nationally recognized in pediatric anesthesia and pain medicine research

■ Leader in the use of infant spinal anesthesia to minimize the need for general anesthesia

Specialized programs Chronic Pain Management Program

Cardiac Anesthesia Program The congenital cardiac anesthesia team delivers specialized care to children and adults with congenital and acquired cardiac disease who are undergoing diagnostic, interventional and surgical procedures.

Harnessing the expertise of pain physicians, psychologists, and physical and occupational therapists, this multidisciplinary program provides psychological and procedural support for pediatric patients with chronic pain.


Annals of Cardiac Anesthesia: April – June 2022 Spinal Anesthesia for Open

Leading-edge technologies in cardiac anesthesia

Our Chronic Pain Management Program treated nearly 1,000 patients in 2022.

Gastrostomy in an Infant After Stage I Norwood for Hypoplastic Left Heart Paediatric Anaesthesia: April 2022 Ipsilateral Double Arterial Puncture in Children Journal of Pediatric Psychology: February 2022 Cross-Sectional Associations Among Components of Injustice Appraisals and Functioning in Adolescents with Chronic Pain

TEG 6S, a new point-of-care diagnostic modality, allows real-time assessment and treatment of bleeding disorders during cardiac surgery.

Anesthesia Encounters: 2020 – 2022 2020*



Riley Hospital for Children Main OR

Acute Pain Management Program Skilled anesthesiologists provide leading-edge pain management for inpatient and outpatient procedures; use regional anesthesia and pain management protocols to enhance recovery and mitigate unwanted side effects.




Transplant Anesthesia Program Providing 24/7 coverage for complex transplant cases, our physicians specialize in anesthesia care for children undergoing intra-abdominal and multivisceral transplants.




Riley Outpatient Center

Riley Children’s Health at IU Health North





18,186 22,612 24,800

* Total number of encounters in 2020 impacted by reduction in procedures during the COVID-19 pandemic.

Annual Report 2022 – 2023

Home to a high-volume, nationally ranked pediatric cardiology program, Riley Children’s Health delivers the full continuum of cardiac care from fetuses and premature infants to adults with congenital heart disease. Achieving exceptional patient outcomes, the Riley Heart Center has experienced significant growth in recent years. In addition to offering specialists in every clinical area of cardiology, we are active in research to address unmet needs in pediatric cardiology. CARDIOLOGY

Specialized programs Fetal Cardiology Program

Partners in the Fetal Center, our cardiologists offer in- depth diagnostic imaging, evaluation and consultation during pregnancy to develop a comprehensive treatment plan. Cardiovascular Genetics Program Fully integrated CV genetics program provides testing, evaluation and consultation for the full spectrum of heritable heart conditions: ■ Aortopathy ■ Cardiomyopathy ■ Inherited arrhythmia ■ Pulmonary hypertension ■ Familial lipid disorders ■ Congenital heart disease/ syndromes Home Monitoring Program ■ Home monitoring has expanded beyond single ventricle to heart failure patients (2021) and to ventricular assist device and post-heart transplant patients (2022) ■ Monitored 29 babies in 2022 ■ 0% mortality after discharge for single ventricle home monitoring population since 2016 *** Hospital Discharge Virtual Follow-up and Management Program The Riley Heart Center’s innovative advanced practice provider-led virtual care model improves access, minimizes readmission and addresses barriers to care.

DIVISION CHIEF Larry W. Markham, MD, FAAP, FACC Phillip Murray Professor of Pediatric Cardiology; Professor, Departments of Pediatrics and Medicine, IU School of Medicine > Connect with Dr. Markham on Doximity. >

Program distinctions


■ Ranked among the leading pediatric heart programs in the nation by U.S. News & World Report

■ Part of the Cardiac Developmental Biology group in the IU School of Medicine Herman B Wells Center for Pediatric Research

■ TOMORROW clinical trial for children with pulmonary arterial hypertension

26 board certified physicians


■ National leader in patient outcomes with mortality rates below benchmark *

See full team member list

National program affiliations and accreditations ■ Intersocietal Accreditation Commission ■ Cardiac Neurodevelopmental Outcome Collaborative ■ Adult Congenital Heart Association ■ Pulmonary Hypertension Center of Comprehensive Care ■ Engineering in Medicine Institute pilot program to study myofibroblasts in dystrophin-deficient cardiac disease progression ■ U.S. Department of Defense-funded study ** to define cell populations and cell type-specific transcriptional dysregulation in pediatric coarctation of the aorta


■ Integrated care model with subspecialty care coordination and novel approaches

to cardiac intensive care, inpatient navigation and home monitoring

Journal of the American Heart Association: October 2022

Learning to Crawl: Determining the Role of Genetic Abnormalities on Postoperative Outcomes in Congenital Heart Disease Progress in Pediatric Cardiology: April 2022 The Successful Use of Verapamil in Infants with Fascicular Ventricular Tachycardia Circulation, Cardiovascular Quality and Outcomes: December 2022 Perioperative Considerations for Pediatric Patients with Congenital Heart Disease Presenting for Noncardiac Procedures: A Scientific Statement from the American Heart Association Cardiology in the Young: July 2022 Utilizing Technology to Expand Home Monitoring to High-Risk Infants with CHD

■ Only formalized comprehensive adult congenital heart disease program in Indiana; program accredited by the Adult Congenital Heart Association

2021 539 visits completed

2022 625 visits completed

Mean timing of virtual visit: 2.8 days after hospital discharge

Significant issues addressed: Neonatal feeding concerns, additional education about upcoming surgery, medications, prognosis, symptom management, ordering interval testing and arranging for home equipment Results: ■ Appropriate escalation of care, potentially preventing patient harm ■ Synchronized visits with support services (dietary, social work, pharmacy) ■ Added convenience for patient families

Fetal Echocardiogram Volume: 2018 – 2022

Echocardiogram Interpretations: 2018 – 2022 Our program serves more than 40 Indiana hospitals and is achieving record volumes.

Performed at nine locations across Indiana.





17,362 17,938 17,887


1,647 1,670

39 research publications in 2022











*** As of Dec. 31, 2022

* Source: The Society of Thoracic Surgeons (STS) Table 16, Harvest Report, published January 2023 for period ending June 30, 2022 ** The U.S. Army Medical Research Acquisition Activity, 820 Chandler Street, Fort Detrick, MD, 21702-5014, is the awarding and administering acquisition office. This work was supported by The Assistant Secretary of Defense for Health Affairs endorsed by the Department of Defense, in the amount of $317,000, through the Peer Reviewed Medical Research Program under Award Number HT9425-23-1-0009. Opinions, interpretations, conclusions and recommendations contained herein are those of the author(s) and are not necessarily endorsed by the Department of Defense.

Refer a patient online

Annual Report 2022 – 2023


Researchers at Riley Children’s Health have received a Department of Defense Discovery Award * to study coarctation of the aorta, a common congenital heart defect in babies. Find out about this research to identify targets responsive to early interventions. INNOVATORS >

“Critical coarctation of the aorta is immediately life-threatening, and treatment currently requires surgery that is invasive and technically challenging. Single-cell RNA sequencing is a technology well suited for studying coarctation, which often has a complex geometrical structure and contains multiple different types of cells in the tissue.”

Benjamin J. Landis, MD Riley cardiologist Associate Professor of Pediatrics, IU School of Medicine > Connect with Dr. Landis on Doximity.

Poonam M. Puranik, MD, is a pediatric cardiologist with the Riley Heart Center.

* The U.S. Army Medical Research Acquisition Activity, 820 Chandler Street, Fort Detrick, MD, 21702-5014, is the awarding and administering acquisition office. This work was supported by The Assistant Secretary of Defense for Health Affairs endorsed by the Department of Defense, in the amount of $317,000, through the Peer Reviewed Medical Research Program under Award Number HT9425-23-1-0009. Opinions, interpretations, conclusions and recommendations contained herein are those of the author(s) and are not necessarily endorsed by the Department of Defense.

The cardiovascular surgeons at Riley Children’s Health treat and manage the full spectrum of heart defects—from the most common to the most rare and complex. Practicing at the highest level of board certification, our heart surgeons offer a degree of expertise found only in the most advanced pediatric hospitals. CARDIOTHORACIC SURGERY


We follow the short- and long-term clinical outcomes of patients undergoing congenital cardiac surgeries and assess outcomes following: ■ Ross procedure ■ Pulmonary valve replacement ■ Single ventricle palliation (particularly following the

Program distinctions

Specialized programs ■ Heart Transplant/Mechanical Circulatory Support Program ■ Cardiovascular Genetics Program ■ Aortopathy Program ■ Adult Congenital Heart Program ■ Single Ventricle Home Monitoring Program ■ Ventricular Assist Device Home Monitoring Program ■ Fontan Program

DIVISION CHIEF Mark W. Turrentine, MD John W. Brown Professor of Cardiothoracic Surgery, IU School of Medicine UNOS primary surgeon † > Connect with Dr. Turrentine on Doximity. >

Fontan procedure) ■ Aortic valve repair

■ Ranked among the leading pediatric heart programs in the nation by U.S. News & World Report ■ Only pediatric and adult congenital transplant program in Indiana; program accredited by the Adult Congenital Heart Association

Mark D. Rodefeld, MD, has received multiple National Institutes of Health grants for his work to develop a blood pump designed to provide cavopulmonary assist in a univentricular Fontan circulation. The pump has the potential to dramatically improve the health of children and adults born with single ventricle heart disease.

3 board certified physicians

See full team member list >

■ One of only 13 programs in the nation capable of implanting total artificial hearts in children

† IU Health Transplant is the only transplant center in Indiana with a United Network for Organ Sharing (UNOS)-approved pediatric program for all organs. This designation is based on the level of training and experience of IU Health Transplant’s surgical and medical directors.

30-day Survival: 2020 – 2022

Index operations **

All operations

99% 98% 97%

95% 94% 93%



■ One of the highest volume centers nationwide for the Ross procedure


Journal of Cardiac Surgery: August 2022 Perioperative and Long-Term Outcomes of Ross Versus Mechanical Aortic Valve Replacement

■ Seven decades of experience with right ventricular outflow tract reconstruction


** The first operation of a hospitalization that has an operation type of “CPB” or “No CPB Cardiovascular.”

Postoperative Overall Complications The Society of Thoracic Surgeons (STS) Participant Dashboard for period July 1, 2018 – June 30, 2022 No complications identified Riley Children’s 67.19% STS overall 59.64%

The Riley Heart Center is consistently recognized by The Society of Thoracic Surgeons (STS) for lower than expected operative mortality.

Journal of the American Heart Association: September 2022

Learning to Crawl: Determining the Role of Genetic Abnormalities on Postoperative Outcomes in Congenital Heart Disease Pediatric Cardiology: June 2022 Impact of Home Monitoring Program and Early Gastrostomy Tube on Interstage Outcomes following Stage 1 Norwood Palliation

Operative and Adjusted Operative Mortality*






One or more complications identified Riley Children’s 32.81%

STS overall 35.96%





STAT Category 1 (Least risk)





Ventricular Assist Device Volume: 2013 – 2022






STAT Category 2





STAT Category 3

Mark W. Turrentine, MD , was one of the first surgeons in the nation to use the Berlin Heart to manage a child in heart failure. His expertise was instrumental in securing Food and Drug Administration approval of the device.





STAT Category 4



2 2 2

STAT Category 5 (Most risk)







0 0








2020 2021 2022

* Source: The Society of Thoracic Surgeons (STS) Table 16, Harvest Report, published January 2023 for period ending June 30, 2022

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Annual Report 2022 – 2023

(heart) 317.944.7150 | (lung or throat) 317.944.2394

Child Protection at Riley Children’s Health offers multidisciplinary clinical services and education to improve the evaluation and care of maltreated children. Our team of board certified physicians provides evidence-based consultation in cases of suspected child maltreatment. These consultations are objective assessments to help determine the extent of injury and whether medical cause or accidental mechanism accounts for the injury pattern. CHILD PROTECTION


Our physicians are currently engaged in research related to: ■ Evaluation of physical abuse when domestic violence occurs ■ Disparities in evaluation and reporting of drug ingestions by children ■ Caregiver understanding of adverse childhood experiences (ACEs) ■ Radiography use in assessing possible child maltreatment – Use of postmortem body CT scans to evaluate occult injuries – Spinal fractures in children evaluated for nonaccidental trauma ■ Analysis of demographics in child maltreatment evaluation using skeletal surveys as a proxy and employing multicenter trauma databases ■ Spatial distributions of child trauma and fatalities in Marion County, Indiana

Children Served: 2022 Child abuse consults: 4,733 Pediatric Center of Hope consults: 750 Crisis counseling: 1,555 DCS consults: 5,483 The child protection team led 48 community education programs.

See full team member list DIVISION CHIEF Shannon L. Thompson, MD, FAAP Associate Professor of Clinical Pediatrics, IU School of Medicine > Connect with Dr. Thompson on Doximity. > 5 board certified physicians >

Program distinctions

■ Only physicians in Indiana who are board certified in child abuse pediatrics

■ Consults with the Indiana Department of Child Services (DCS) on more than 5,000 cases of suspected child maltreatment each year ■ Extensive history of collaboration and care coordination with healthcare providers, child protection case managers, law enforcement and the judicial system


Child Abuse & Neglect: November 2022 Chest CT in the Evaluation of Child Abuse – When Is It Useful? American Journal of Roentgenology: December 2022 Radiologists’ Diagnostic Performance in Differentiation of Rickets and Classic Metaphyseal Lesions on Radiographs: A Multicenter Study American Journal of Roentgenology: January 2022 Whole-Spine MRI in Children with Suspected Child Abusive Head Trauma

■ Home to one of only 31 ACGME-accredited child protection fellowship programs in the nation

Physical and Sexual Abuse Consultations by Year: 2018 – 2022


5,572 5,355 5,483

Specialized programs Child Abuse Consultation Service

Foster Care Bridge Program Encounters: 2019 – 2022


Our team facilitates comprehensive medical evaluations for children alleged to have been physically abused or neglected. Foster Care Bridge Program Riley Children’s offers a multidisciplinary clinic to serve as a bridge—providing comprehensive healthcare and acquiring appropriate resources for children entering and making transitions within the foster care system until a permanent medical home is identified. Pediatric Center of Hope Our specialists in child abuse pediatrics provide comprehensive medical evaluation for children alleged to










Docs InCASE Program In collaboration with 15 pediatric practices across the state, we facilitate pediatric care and coordination in advancing the medical role in child protection.

Our specialists are active in national and local organizations, including: ■ American Academy of Pediatrics Council on Child Abuse and Neglect ■ U.S. Department of Health and Human Services Children’s Justice Act Task Force ■ USA Gymnastics Safe Sport Committee ■ Ray E. Helfer Society

have been sexually abused. Crisis Counseling Services

■ Children’s Policy and Law Initiative of Indiana ■ Local and state child fatality review teams and child advocacy centers

These services bridge the gap from the time a child is identified as a possible child sexual abuse victim to when formal ongoing counseling may become available.

Refer a patient online

Annual Report 2022 – 2023



The expert cardiac critical care physicians at Riley Children’s Health provide specialized care for critically ill newborns, infants, children and adolescents with congenital and acquired heart disease. Our high-acuity, high-volume CVICU includes 23 beds for CVICU patients and an eight-bed specialized neonatal ICU. CARDIAC CRITICAL CARE


Founding member and coordinating center: Collaborative Research in Pediatric Cardiac Intensive Care (CoRe-PCIC) network ■ Includes 32 U.S. sites participating in several ongoing research projects Riley Children’s is part of the Pediatric Cardiac Critical Care Consortium (PC4), which uses registry data from more than 60 congenital heart programs to evaluate best practices and drive improvements. ■ 17 critical care studies currently underway, including 10 funded by the National Institutes of Health and two funded by the Centers for Disease Control and Prevention. Leading-edge technologies ■ Continuous renal replacement therapy (CRRT) – In addition to a multidisciplinary CRRT program, Riley Children’s offers aquapheresis to remove excess fluid accumulation in critically ill neonates and children. ■ Etiometry software – All CVICU rooms are equipped with this FDA-approved software visualization application to collect, store and present ICU data in near real-time. High-volume pediatric ECMO center ■ 70 patients treated (73 runs) with extracorporeal membrane oxygenation (ECMO) in 2022 (institution record; up from 57 in 2021). ■ Over the past five years, our overall survival rate for ECMO patients is nearly 60% (above the national average). The ECMO program at Riley Children’s is designated a Platinum Level Center of Excellence by the Extracorporeal Life Support Organization. To date, we have treated more than 1,200 patients with ECMO.

Program distinctions

DIRECTOR Riad Lutfi, MD Associate Professor of Clinical Pediatrics, IU School of Medicine > Connect with Dr. Lutfi on Doximity.


■ Ranked among the leading pediatric heart programs in the nation by U.S. News & World Report

■ Only program in Indiana to offer pediatric heart transplantation and mechanical circulatory support capability ■ Indiana’s only pediatric hospital with a formal Extracorporeal Cardiopulmonary Resuscitation (ECPR) Program

9 board certified physicians (plus multiple board certified neonatologists and physicians in other specialties)


See full team member list


Respiratory Care: October 2022 A Quality Improvement Initiative to Reduce Unneeded Screening Chest Radiographs in a Pediatric Cardiovascular ICU Pediatric Critical Care Medicine: June 2022 Prophylactic Enoxaparin Against Catheter-Associated Thrombosis in Postoperative Cardiac Children: An Interrupted Time Series Analysis The Annals of Thoracic Surgery: September 2022 Procedural Outcomes of Pulmonary Atresia with Intact Ventricular Septum in Neonates: A Multicenter Study Pediatric Cardiology: June 2022 Pulmonary Atresia with Intact Ventricular Septum: Midterm Outcomes from a Multicenter Cohort

Postoperative Severity – Adjusted CVICU Length of Stay

10.5 days

Risk-adjusted CVICU Surgical Mortality *

Risk-adjusted CVICU Medical Mortality *

8.37 days





Riley Children’s All PC4 ** facilities

Riley Children’s

Aggregate – All

Riley Children’s All PC4 ** facilities

Additional 2022 outcome measures






CLABSI per 1,000 line days (central line-associated bloodstream infection)

0.74 per 1,000



1.36 per 1,000

CAUTI per 1,000 catheter days (catheter-associated urinary tract infection)

0 per 1,000



0.76 per 1,000

Unplanned extubation per 100 ventilator days

0.208 per 100



0.20 per 100

SSI per 100 surgical procedures (surgical site infection)

0.29 per 100



1.41 per 100

* Risk adjustment is a methodological approach incorporating unique patient characteristics that impact patient outcomes and are unrelated to the quality of care delivered by the care team or hospital. ** Pediatric Cardiac Critical Care Consortium | Charts reflect July 1, 2021 – June 30, 2022 , outcomes.

Annual Report 2022 – 2023

877.247.1177 IU Health 24/7 Transfer Center


A 37-bed unit, the Riley Children’s Health PICU provides skilled care to critically ill infants, children and adolescents. According to The Children’s Hospital Association, the PICU located at Riley Hospital for Children in downtown Indianapolis is one of the highest acuity centers in the United States. With all pediatric medical and surgical subspecialties represented, the PICU delivers a collaborative model for the care of a large volume of high-acuity diseases and injuries. PEDIATRIC CRITICAL CARE


■ 18 clinical trials and observational studies underway in critical care at Riley Children’s, including 10 funded by the National Institutes of Health and three funded by the Centers for Disease Control and Prevention ■ Active in studies focused on aspects of multiorgan dysfunction, including ARDS, sepsis, renal failure and ECMO support Professional organization affiliations EXECUTIVE COMMITTEE International Network for Simulation-based Pediatric Innovation, Research and Education (INSPIRE) Kamal M. Abulebda, MD EXECUTIVE COMMITTEE, PediECMO SUBGROUP CHAIR FOR SOCIAL MEDIA AND COMMUNICATIONS, PediECMO SUBGROUP Pediatric Acute Lung Injury and Sepsis Investigators (PALISI) Matthew L. Friedman, MD EXECUTIVE COMMITTEE, HEMATOPOIETIC STEM CELL TRANSPLANTATION AND CELLULAR THERAPY SUBGROUP Pediatric Acute Lung Injury and Sepsis Investigators (PALISI) Courtney M. Rowan, MD, MS CO-CHAIR, PEDIATRIC VENTILATOR WEANING AND LIBERATION GUIDELINES CO-CHAIR, AARC/PALISI PEDIATRIC CRITICAL ASTHMA GUIDELINES Pediatric Acute Lung Injury and Sepsis Investigators (PALISI) Samer M. Abu-Sultaneh, MD, FAAP CO-CHAIR, ICU LIBERATION COMMITTEE Society of Critical Care Medicine Samer M. Abu-Sultaneh, MD, FAAP REGISTRY SCHOLARLY OVERSIGHT COMMITTEE CO-CHAIR FOR PUBLICATIONS Extracorporeal Life Support Organization Matthew L. Friedman, MD Courtney M. Rowan, MD, is also a member of the Pediatric Acute Lung Injury Consensus Committee charged with writing PARDS guidelines.

DIVISION CHIEF Adnan Bhutta, MD, FAAP, FCCM Professor of Pediatrics, IU School of Medicine > Connect with Dr. Bhutta on Doximity. >

Program distinctions

Leading-edge technologies ■ Etiometry ■ High-frequency oscillatory ventilation ■ Inhaled nitric oxide ■ Kinetic therapy rotational bed ■ Continuous renal replacement therapy (CRRT) ■ Aquapheresis Committed to quality and safety ■ 77 patients were supported with CRRT at Riley Children’s in 2022—an institution record. In addition, the Riley PICU provided postoperative care for nearly 20 children undergoing solid organ transplants. ■ PICU Up! early mobility program focuses on early involvement of physical and occupational therapy to improve mobility and muscle strength, and promotes liberation from mechanical ventilation and prevention of ICU delirium. ■ The Riley PICU maintained an unplanned extubation rate of 0.7 events per 100 mechanical ventilation days; national benchmark is 0.9.

■ Platinum Level ECMO Center of Excellence designated by the Extracorporeal Life Support Organization ■ Only pediatric program in Indiana with a formal Extracorporeal Cardiopulmonary Resuscitation (ECPR) Program

18 board certified physicians


See full team member list


■ Indiana’s only pediatric hospital with a dedicated burn ICU

The Journal of Pediatrics: January 2022 Improving Pediatric Readiness and Clinical Care in General Emergency Departments: A Multicenter Retrospective Cohort Study Journal of Burn Care & Research: October 2022 Safety and Efficacy of Propofol and Ketamine Based Procedural Sedation Regimen in Pediatric Patients During Burn Repetitive Dressing Change: 10 Years Single Center Experience Blood Advances: March 2022 A Biomarker Panel for Risk of Early Respiratory Failure Following Hematopoietic Cell Transplantation

■ Center of Excellence in Pediatric Sedation; designated by the Society for Pediatric Sedation


PICU Annual Admissions: 2019 – 2022


2,083 1,992

Record high admissions and average daily census of 34.96





73 research publications in 2022

Specialized programs Procedural Sedation Team

■ Averaging more than 100 procedural sedations per month, our team provided care to 1,308 patients in 2022.

Annual Report 2022 – 2023

877.247.1177 IU Health 24/7 Transfer Center

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