Riley Children's Health Annual Report 2021



Table of contents Welcome to Riley Children’s Health About Riley Children’s Health Honored to be a nationally ranked children’s hospital Pediatric specialties Adolescent Medicine Allergy and Immunology Anesthesiology Cardiology

Riley Children’s Health Leadership Team Gil Peri President Elaine G. Cox, MD Chief Physician Executive Mara E. Nitu, MD, MBA

Since opening our doors nearly a century ago, Riley Children’s Health has never wavered in our commitment to provide exceptional healthcare to children and families. Recognized for delivering advanced clinical care and evidence-based treatment, Riley Children’s is proud to be one of the nation’s leading children’s hospitals with 10 specialties ranked by U.S. News & World Report . This year, that list includes three in the top 10—Urology, Cardiology & Heart Surgery, and Pulmonology & Lung Surgery.

Cardiothoracic Surgery Child Protection Program

Chief Medical Officer Emily C. Webber, MD Chief Medical Information Officer John Harding, MBA Chief Operating Officer Megan Isley, DNP, MSN, RN Chief Nursing Officer Tyler Leishman Chief Strategy Officer Frank Runion Chief Financial Officer Mark Anderson Chief Human Resources Officer D. Wade Clapp, MD Chairman, Department of Pediatrics, IU School of Medicine Frederick J. Rescorla, MD Surgeon-in-Chief

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

At Riley Children’s, our longstanding research and clinical partnership with Indiana University School of Medicine results in an environment that’s rich in opportunity to engage in novel research. On the pages of this annual report, you’ll find examples in every pediatric specialty of the ways our physicians and physician-scientists are advancing care that helps children live longer and healthier lives. With quality and patient safety among our highest priorities, Riley Children’s continues as a partner in the Children’s Hospitals’ Solutions for Patient Safety, a hospital network that shares best practices for delivering preeminent care. As experts in caring for children and adolescents with complex medical needs, Riley Children’s has earned multiple distinctions, including verification as both a Level I Pediatric Trauma Center and a Level I Children’s Surgery Center by the American College of Surgeons. Riley Children’s is one of only 11 programs worldwide designated as a Platinum Level Center of Excellence by the Extracorporeal Life Support Organization. Delivering unmatched clinical care and advancements in pediatric medicine takes a team of talented and committed individuals. At Riley Children’s, we’re fortunate to work alongside such a dedicated group— physicians, researchers, advanced practice providers, nurses, other medical professionals and patient care team members—who are devoted to improving the lives of children and families. On behalf of our care team, we invite you to learn more about our pediatric health system and the impact we’re making in the lives of children both here in Indiana and beyond.

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 Neurointerventional Radiology Neurology 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

> A top 10 leader in NIH-funded pediatric research > Distinctive CV care model outperforms national average for neonatal operative mortality > A partner in building strong communities > Improving health and well-being close to home > Multimillion-dollar gift to boost Riley’s expertise in Duchenne muscular dystrophy > Interdisciplinary BPD program improves clinical outcomes for vulnerable newborns > Retinoblastoma program offers intra-arterial chemotherapy as first-line treatment

Elaine G. Cox, MD Chief Physician Executive, Riley Children’s Health Professor of Clinical Pediatrics, IU School of Medicine Connect with Dr. Cox on Doximity.

Brian E. Wagers, MD Associate Chief Medical Officer; Physician Director of Pediatric and Maternal Quality and Safety, Riley Children’s Health Associate Professor of Clinical Emergency Medicine and

Pediatrics, IU School of Medicine Connect with Dr. Wagers on Doximity.


By the numbers A look at patient care in 2021

Riley Children’s Health, Indiana’s largest and most skilled pediatric health system, provides care in 18 communities across the state. Children’s Surgery Verification


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

1 Level IV NICU 2 Level III NICUs

■ Eighth-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 2021


“Riley team members provide the best care for children, not only to Hoosiers, but for others across the Midwest and the nation. Our team has dedicated their lives to improving child development, health and well-being.” – Gil Peri President, Riley Children’s Health

Riley Children’s Health is ranked among the top children’s hospitals in the nation by U.S. News & World Report . In 2022-23, we are ranked in 10 out of 10 pediatric specialties. Below are some of the factors that contribute to our standing as a leader in pediatric healthcare. (See the specialty sections in this report for more details.)


DIVISION CHIEF David S. Hains, MD ■ One of only 12 pediatric programs in the nation to offer aquapheresis, allowing for continuous renal replacement 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 DIRECTOR, NEUROLOGY Laurie L. Ackerman, MD, FAANS, FAAP | Christopher T. Jackman, MD ■ 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 epilepsy center INTERIM DIVISION CHIEF, NEUROSURGERY DIVISION CHIEF Christine B. Caltoum, MD ■ 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 DIVISION CHIEF James F. Chmiel, MD, MPH, ATSF ■ One of the top five largest cystic fibrosis programs in the nation; only program in Indiana accredited by the Cystic Fibrosis Foundation ■ Home to the Infant Breathing Program, providing interdisciplinary care to prematurely born infants; reduces mortality and the number of infants needing tracheostomies DIVISION CHIEF Rosalia Misseri, MD ■ One of seven Congenital Adrenal Hyperplasia (CAH) Comprehensive Care Centers in the U.S. (designated by the CARES Foundation) ■ One of the few Midwest facilities to offer robotic surgery and a complete program for adults with congenital urologic conditions



■ Greater access to clinical trials through CureWorks, the Children’s Oncology Phase 1 Consortium and the Pacific Pediatric Neuro-Oncology Consortium ■ One of the few pediatric cancer programs in the region to offer precision genomics to treat children with relapsed or aggressive cancer



Cardiology & Heart Surgery

Larry W. Markham, MD, FAAP, FACC | Mark W. Turrentine, MD ■ Recognized by U.S. News & World Report as the Midwest’s best hospital for children’s heart care ■ National leader in patient outcomes with mortality rates below benchmark*

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


DIVISION CHIEF Jean P. Molleston, MD

Gastroenterology & GI Surgery

■ Home to leading multidisciplinary programs for intestinal rehabilitation, eosinophilic disorders, IBD, liver, motility and aerodigestive disorders, and weight management ■ Pediatric psychology program dedicated to treat psychological conditions related to GI disease DIVISION CHIEF Laura S. Haneline, MD ■ Precision genomics program for critically ill newborns; only program of its kind in the nation ■ Innovative cardiac NICU with neonatology integration and daily rounds with CV intensivists and cardiologists that contribute to stellar outcomes

Pulmonology & Lung Surgery





* Source: Society of Thoracic Surgeons (STS) Table 16, Harvest Report, published July 2022 for period ending June 30, 2021

Annual Report 2021

In partnership with Riley Children’s Health, 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.

A top 10 leader in NIH- funded pediatric research

8 Driving new treatments for complex diseases Riley Children’s Health researcher leads national effort to develop treatments for inherited childhood cancers D. Wade Clapp, MD, chairman, Department of Pediatrics, IU School of Medicine, is leading an $11.4 million grant from the National Cancer Institute to develop new treatments for tumors that develop in neurofibromatosis type 1 (NF1), the most common inherited syndrome causing a predisposition to cancer. One of 63 Specialized Programs of Research Excellence (SPORE) grants throughout the country, this IU School of Medicine grant is the only one focused on childhood cancers. Combination therapy blocks osteosarcoma tumor growth in models A combination therapy pioneered by the Precision Genomics team at Riley Children’s significantly slows osteosarcoma tumor growth in models. The models were developed from the cells of tumors donated by Riley patient Tyler Trent, who waged a long and valiant battle against the disease. The research was published in the international journal, Cancers. “Big data” analysis reveals androgens could benefit asthma Riley Children’s and IU School of Medicine researchers discovered that people who are clinically lacking androgen effects are three to four times more likely to have asthma than people in the general population. Published in JAMA Pediatrics, this “big data” analysis supports previous work in mice showing Riley Children’s Health and the Indiana University School of Medicine Department of Pediatrics rank eighth in the nation for National Institutes of Health (NIH) funding.

Generating insights that improve patient care and outcomes

Renowned immunology researcher receives $12 million for safer hemophilia treatments Roland Herzog, PhD, Riley Children’s Foundation Professor of Immunology, is leading a multi- institute effort toward improved therapies for hemophilia with help from a grant from the NHLBI. The award funds basic and translational studies that explore a gene therapy approach that could lead to safer—and potentially curative—treatments. Multimillion-dollar grant to study impact of drugs in pregnant women and children With a five-year, $17.1 million grant from the NIH, Riley Children’s and IU School of Medicine researchers are studying how certain drugs and medications affect pregnant and lactating women and their children. Study shows benefits of cardiac home monitoring, nutrition management Riley cardiology specialists led a published study showing the benefits of nutrition management and home monitoring programs in improving interstage morbidity and mortality in patients with hypoplastic left heart syndrome.

Simulation education boosts providers’ skills, knowledge In a study led by Riley neonatologists and published in Pediatrics, simulation education regarding preterm infant delivery room management improved community providers’ knowledge and skills. Adaptations in care delivery impact infant mortality rates A Riley study report published in Pediatrics outlines how adapting the March of Dimes’ Interventions to Minimize Preterm and Low Birth Weight Infants Through Continuous Improvement Techniques (IMPLICIT) toolkit for pediatrics can impact infant mortality rates. First known study in U.S. evaluates asymptomatic COVID-19 infection in children and adults TACTIC (Tracking Asymptomatic COVID-19 Through Indianapolis Communities), a study conducted early in the pandemic, showed that asymptomatic COVID-19 infection was possible in children younger than 10 years old.

that loss of the androgen receptor increases asthma risk. Researchers pursue personalized therapies for severe asthma

A group of researchers led by Riley pulmonologist Benjamin Gaston, MD, received a $12 million research program project grant (P01) from the National Heart, Lung and Blood Institute (NHLBI) to fund the development of personalized therapeutic approaches for severe asthma. The grant will fund three key projects related to severe asthma: S-nitrosylation signaling, airway pH regulation and androgen signaling. NIH funding to help find uniformly accepted treatment for NOWS Neonatologists at Riley Children’s received funding through the NIH’s Helping to End Addiction Long-Term (HEAL) Initiative and are participating in a national multicenter trial to find a uniformly accepted treatment for neonatal opioid withdrawal syndrome (NOWS).

Annual Report 2021

Distinctive CV care model outperforms national average for neonatal operative mortality

“All of our subspecialists see the value in co-managing the care of these complex patients—most of whom have more medical issues than just a congenital heart anomaly.” – Laura S. Haneline, MD Division Chief, Neonatology






Neonates | All STAT Mortality Categories

Observed to expected ratio 0.52





*Source: Society of Thoracic Surgeons (STS) Table 16, Harvest Report, published July 2022 for period ending June 30, 2021

A unique shared management cardiac care model developed by specialists at Riley Children’s Health is contributing to neonatal operative mortality rates that are far better than the national average, based on the most recent data released by the Society of Thoracic Surgeons (STS). Contributing to stellar care in the treatment of neonates who need cardiac surgery or intervention, the collaborative care model is built on shared management between neonatologists, cardiac intensivists, cardiovascular surgeons, cardiologists and anesthesiologists.

Neonates requiring surgery or cardiac intervention are admitted to Riley’s cardiovascular intensive care unit under the primary care of neonatologists with cardiac intensivists and cardiologists providing consult. Cardiothoracic surgery and cardiac intensivists transition to primary service following surgery or intervention through the initial recovery period, with neonatology picking back up, along with cardiology, as primary services as the babies progress toward discharge from the Riley Heart Center. “Neonates with complex congenital heart disease are patients undergoing the highest risk interventions and have unique needs,” said Larry W. Markham, MD, FAAP, FACC, cardiology division chief. “The forward thinking by Riley neonatologists and cardiac intensivists, followed by the acceptance from cardiothoracic surgery and cardiology, has delivered a model that attends

to these needs of the neonatal patient and family. This model has consistently delivered exceptional results, even in the face of significant increases in volume and complexity.” Laura S. Haneline, MD, neonatology division chief, said the recent expansion of the Fetal Center has also contributed to improved outcomes for neonates with congenital heart disease. Riley neonatologists and cardiologists are part of the center’s multidisciplinary team that supports expert coordinated management of complex and high-risk fetal conditions, including cardiac abnormalities. “For all of the Riley specialists involved in treating babies with serious congenital heart conditions, it’s really our shared vision and commitment to providing the very best care that’s made this model such a success,” Dr. Haneline said.

The model, which integrates the expertise of Riley neonatologists and cardiologists in all phases of the first hospitalization, is executed by less than

10% of the nation’s pediatric hospitals.*

* Children’s Hospitals Neonatal Consortium survey

Annual Report 2021


As one of the Midwest’s largest and most comprehensive children’s healthcare systems, Riley Children’s Health uses our expertise and resources to support populations and communities in Indiana and around the world.

Riley Children’s rallies around Afghan children in need Hospitalists and emergency medicine physicians collaborated with advanced practice providers and other care teams at Riley Children’s to develop a refugee service that cared for children and families evacuated from Afghanistan. The refugees were relocated to temporary housing at the Indiana National Guard’s Camp Atterbury, located 35 miles south of Riley Hospital for Children at IU Health.

Heart center team saves lives overseas In early 2022, a team of cardiovascular surgeons and cardiologists from Riley Children’s traveled to Amman, Jordan, where they operated on a dozen children—some from Iraq, some from Jordan and some living in refugee camps in the Middle East. For Riley pediatric cardiothoracic surgeon Mark W. Turrentine, MD, it’s the 32nd medical mission trip he’s made to Jordan over the past 15 years. “It’s pretty meaningful to see something good happen for families that are fairly desperate to have something good happen to them,” said Dr. Turrentine. Riley pediatric cardiologist Anne G. Farrell, MD, who traveled with the team this year and in years past, agrees. “Being able to affect kids’ lives so dramatically—when they otherwise have no chance—is really rewarding,” she said. Dr. Farrell shared the story of Danial, who traveled from Iraq with his mother. He was so weak and cyanotic that he was unable to walk before surgery. Two days later, he was kicking a soccer ball down the hospital hallway. “That’s life-changing,” Dr. Farrell said. Funding partners continue to make the lifesaving missions possible, but the teams that travel overseas are donating their time. “I’m really proud of the group that goes,” Dr. Turrentine said. “I’m just always very proud to travel with the Riley Heart Center team on these trips because no one could imagine how hard they work and the passion they have for it.”

“It is meaningful for us to take care of any child and family who needs us here in Indiana, whether they’ve been here for generations, or they just arrived a couple of weeks ago.” -- E lizabeth Weinstein, MD Division Chief, Emergency Medicine “It’s been such a privilege to carry this out at Riley Children’s, to show our Hoosier hospitality to people who are escaping a very scary situation.” -- R achel J. Peterson, MD Pediatric Hospitalist “It’s what we do when we know there are people in need. We want them to have a better life.” -- M ichele L. Saysana, MD “You can’t plan for when things happen, but when people need you, that’s when you have to step up. It makes me even more proud to work at Riley Children’s.” -- S tayce L. Woodburn, NP Advanced Practice Provider IU Health Chief Quality and Safety Officer, and Pediatric Hospitalist

Support for surgery program in Guatemala Since 2001, Riley urology surgeon Martin Kaefer, MD, FAAP, has led a 20-person team of healthcare providers, including surgeons and anesthesiologists, to Guatemala City to provide educational support for pediatric surgeons at Roosevelt Hospital. Riley Children’s has collaborated with colleagues at Roosevelt to establish the first training program in pediatric surgery/urology at the Guatemalan hospital.

Health Care Heroes: Unit’s care goes beyond treating illness The Riley team that cared for the Afghan refugees in 2021 was honored by the Indianapolis Business Journal as Health Care Heroes .

Annual Report 2021

Meeting the health needs of diverse populations Riley Children’s is committed to creating a culture of diversity, equity and inclusion (DEI) as we strive to contribute to making Indiana one of the nation’s healthiest states. Our vision is to advance and accelerate a culture of access, equity and inclusion. Examples of our work to promote DEI ■ Riley allergy and immunology specialists study the role of food deserts on outcomes of children with asthma. In Indianapolis, food deserts disproportionately affect Black children. ■ Physicians with the Riley Child Protection Program are involved in scholarly work addressing disproportionality and disparities in Indiana’s foster care system. ■ Audiologists with the Cochlear Implant Program at Riley Children’s conduct speech perception testing in Spanish to more accurately diagnose and treat Spanish-speaking patients with hearing loss. ■ The Riley critical care team is evaluating communication between the medical team and culturally diverse families of critically ill children, specifically addressing the delivery of end-of-life care. Ongoing quality improvement studies and targeted interventions are aimed at providing equitable, compassionate care to all. ■ As part of the Arthritis Foundation’s “Cultivating a New Generation of Rheumatologists” program, Riley rheumatologist Martha M. Rodriguez, MD , developed a pediatric rheumatology curriculum for medical students who are underrepresented in medicine.


Vaccine outreach – To provide greater access to COVID-19 vaccines for children age 5 to 11, Riley Children’s Health hosted five vaccination clinics in fall 2021. The events were held both on site at Riley Hospital for Children at IU Health and at The Children’s Museum of Indianapolis. Approximately 500 COVID-19 vaccines were administered during the clinics. Two other clinics at the museum offered free flu vaccines. Be Happy program – Riley Children’s implements the Indiana Behavioral Health Access Program for Youth (Be Happy)—the first and only child psychiatry access program in the state. This program supports pediatric physicians and advanced practice providers in caring for youth with mental health and substance use disorders. Kidney Camp – For nearly two decades, Riley Nephrology has partnered with the National Kidney Foundation of Indiana to host a summer camp for children with kidney disease and survivors of kidney transplant. Indiana Emergency Medical Services for Children Program – Riley physicians oversee this community outreach initiative, which includes an emergency care course for school nurses. The course is developed and executed in partnership with the Indiana Department of Education and is free to school nurses throughout the state.

Project ADAM – Riley Children’s is the first healthcare facility in Indiana to assist schools in becoming certified as “Heart Safe” through Project ADAM. With affiliates nationwide, the sudden cardiac arrest program is designed to promote awareness, AED training and emergency response. Riley Children’s helped certify Indiana’s first Heart Safe school in May 2021. Pediatric Community Outreach Mobile Education (PCOME) – Pediatric intensivists at Riley Children’s provide on-site simulation training and education to community hospital healthcare providers for the initial stabilization and management of pediatric patients. COVID-19 communications training – Riley emergency medicine physicians provided healthcare communications training to Indiana 211 call center representatives, who were responsible for scheduling Indiana residents for vaccines and answering vaccine- related questions. ThinkFirst – Riley Children’s is a member of ThinkFirst, a national organization that works to prevent brain, spinal cord and other traumatic injuries. Pediatric neurosurgeons at Riley Children’s provide related education to primary care physicians and pediatricians. Using hospital prearrival data, the team also conducts research to examine traumatic brain injury outcomes. Findings have resulted in emergency medical services protocol changes throughout Indiana.

Annual Report 2021

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

Specialized programs Adolescent Medicine Consultation Program

We offer evaluation and treatment for any adolescent health concern requiring more specialized treatment than is typical for primary care. Common referrals include: ■ Mental health and behavioral issues, including anxiety and depression ■ 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. We consult patients and families about fertility preservation for adolescents with complex illness, such as heart transplants and congenital heart conditions, sickle cell disease, cystic fibrosis, and cancer. Riley Gender Health Program Our interdisciplinary program offers comprehensive support to children, teens and young adults who are experiencing gender dysphoria and seek supportive and affirmative care. Services include: ■ Gender-affirming hormone therapy ■ Puberty-blocking medication ■ Treatment for menstrual suppression ■ Psychological counseling ■ Surgery referral and coordination

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

Program distinctions

Expanding access to care Riley Adolescent Medicine conducted 1,931 virtual visits in 2021. Through virtual technology, our team treated patients in more than 90% of Indiana’s counties.

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 the few comprehensive programs in the region designed to meet the unique needs of gender-diverse children and adolescents Home to the Charis Center, one of the Midwest’s most comprehensive eating disorders treatment programs

9 board certified physicians

See full team member list >

Research highlights Riley adolescent medicine specialists conduct research in a variety of areas: ■ Human papillomavirus (HPV) ■ HPV vaccines

110 research publications in 2021

Adolescent Medicine Fellowship Riley Adolescent Medicine offers subspecialty training through a three- year fellowship program . Fellows provide clinical care, develop their own research programs, lead resident education and have the opportunity to earn a master’s degree in public health.

■ Sexually transmitted infections ■ Healthcare access for youth ■ Eating disorders ■ Teen pregnancy prevention ■ Gender health ■ Long-term effects of illness and recovery on youth

Charis Center for Eating Disorders The Charis Center delivers multidisciplinary medical, psychological and family services for patients with eating disorders. Inpatient and outpatient treatment options are available.

More than 10,000 outpatient visits

annually with medical, psychological, nutrition,

group therapy and parental support

9 new research grants in 2021 plus 25 active grants

Refer a patient online

Annual Report 2021



Research highlights ■ 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 among infants. ■ Our program participates in five clinical trials and multiple studies investigating the role of the airway microbiome in the development of allergic disease. ■ Riley Children’s 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.

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 board certified physicians offer the latest diagnostic tools and treatments delivered in a safe and comfortable manner to children dealing with the challenges of allergic conditions.

DIRECTOR Girish V. Vitalpur, MD, FAAP, FAAAAI Associate Professor of Clinical Pediatrics, IU School of Medicine Connect with Dr. Vitalpur on Doximity. >

Program distinctions

Recognized for distinction in clinical care by Food Allergy Research and Education (FARE); performs more food challenges than any other program in Indiana

5 board certified physicians

See full team member list >

Notable research publications Contemporary Clinical Trials: January 2021

Our team has implemented an inpatient penicillin allergy de-labeling protocol that is being used in hospitals across the state.

Preventing Asthma in High-Risk Kids (PARK) with Omalizumab: Design, Rationale, Methods, Lessons Learned and Adaptation Journal of Pediatric Gastroenterology and Nutrition: October 2021 The Effects of Patient Demographics on Outpatient Endoscopy Utilization in Children with Eosinophilic Esophagitis

The state’s only multidisciplinary program for eosinophilic gastrointestinal diseases

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 Kirsten M. Kloepfer, MD, MS Nurcicek Padem, MD, MS Craig D. Sewell, DO Girish V. Vitalpur, MD, FAAP, FAAAAI

Partners with the Indiana Department of Health to analyze all abnormal newborn screenings for severe combined immune deficiencies (SCIDs) Member of the Jeffrey Modell Centers Network for treatment and research related to primary immunodeficiency diseases Specialized programs Gastrointestinal Eosinophilic Digestive Diseases Program Our multidisciplinary program allows children to see a pediatric allergist, gastroenterologist and dietitian during the same visit. High-Risk Asthma Program This collaborative program addresses the medical and social needs of children and families with severe asthma. Immunogenetics Program Children with complex immune disorders receive the latest guidance from an immunologist, a geneticist and a genetic counselor. Immunohematology Program Pediatric immunologists and hematologists at Riley Children’s provide expertise in managing conditions for children with autoimmune cell defects.

Food Challenge Tests Conducted: 2019 – 2021




Health disparities research Riley allergy and immunology specialists study the role of food deserts on outcomes of children with asthma. In Indianapolis, food deserts disproportionately affect Black children.

Clinical Immunology Society Jay J. Jin, MD, PhD Nurcicek Padem, MD, MS




New Patient Volume: 2019 – 2021







Refer a patient online

Annual Report 2021


The skilled 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. Our team is also committed to leading innovative perioperative care research, providing high-quality clinical education and improving health outcomes. ANESTHESIOLOGY

Anesthesia Encounters: 2019 – 2021

22,612 TOTAL 2021

19,733 TOTAL 2019

18,186 TOTAL 2020*




Program distinctions

DIRECTOR Brian N. Egan, MD Assistant Professor of Clinical Anesthesia, IU School of Medicine Connect with Dr. Egan on Doximity. > 36 board certified physicians See full team member list >

Committed to quality and safety ■ Our program includes a robust perioperative simulation program with both multidisciplinary in situ and “just in time” simulation training. ■ We participate in Wake Up Safe , a national pediatric anesthesia quality and safety collaborative.

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




Nationally recognized in pediatric anesthesia and pain medicine research




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

Main OR Riley Children's Health at IU Health North Hospital * Total number of encounters in 2020 impacted by reduction in procedures during the COVID-19 pandemic. Riley Outpatient Center

Center for Anesthesia Research Excellence (CARE) Riley Anesthesiology is one of the top National Institutes of Health-funded anesthesia programs in the country aiming to improve clinical research and outcomes in children.

Chronic Pain Visits: 2019 – 2021


Specialized programs Acute Pain Management Program ■ Our anesthesiologists provide leading-edge pain management for inpatients, including regional anesthesia and pain management protocols aimed at speeding recovery while

TOTAL 2021

Anesthesiologists and advanced practice providers at Riley Children’s collaborated with hematology colleagues to develop and implement ketamine infusion protocols for patients with sickle cell disease.




TOTAL 2020*

TOTAL 2019



decreasing unwanted side effects. Chronic Pain Management Program

In 2021, Riley Anesthesiology received more than $1 million in external funding.

■ Multidisciplinary team, comprised of specialized pain physicians, psychologists, and physical and occupational therapists, tailors

treatment to individual needs; therapeutic options include acupuncture and hypnosis. Cardiac Anesthesia Program ■ The congenital cardiac anesthesia team provides specialized anesthesia care to children with congenital and acquired cardiac disease undergoing diagnostic, interventional and surgical procedures. Transplant Anesthesia Program ■ Our team specializes in anesthesia care for children undergoing intra-abdominal organ and multivisceral transplants; 24/7 coverage provided for these complex cases.


Research topics ■ Validation of point-of-care TEG 6s in pediatric cardiac surgical patients ■ Predicting perioperative adverse effects and personalizing analgesia in children ■ Methadone in children undergoing major surgery: inter- child variability in pharmacokinetics and postoperative outcomes ■ Dexmedetomidine dose evaluation study for procedural sedation in children undergoing MRI (industry-sponsored study) ■ Multicenter study evaluating the effects of anesthesia on transplant outcomes



Leading-edge technologies in cardiac anesthesia ■ TEG 6s, a new point-of-care diagnostic modality, allows real-time assessment and treatment of bleeding disorders during cardiac surgery. ■ Studies using serratus anterior plane blocks and liposomal bupivacaine wound infiltration are underway to improve patient comfort following surgery. ■ Five new anesthesia delivery systems bring the advanced features found in ventilators used in postoperative care in the cardiac ICU to the OR and catheterization lab.

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

New patient visits

Return visits

Refer a patient online

Annual Report 2021


Riley Children’s Health, home to a high-volume pediatric cardiology program, 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 patient volume during the past five years. In addition to offering specialists in every clinical area of cardiology, we are active in research to address unmet needs in pediatric cardiology, including single ventricle physiology and heart failure associated with Duchenne muscular dystrophy. CARDIOLOGY

Innovative model expands post-discharge virtual care Experiencing an increase in patient volume and clinical complexity, the Riley Heart Center launched a virtual care model, led by cardiac advanced practice providers (APPs), to improve access, minimize readmission and address barriers to care.

Care model statistics ■ 830 patients scheduled for APP-led virtual visits (October 2020 – April 2022)

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. >

■ Mean timing of virtual visit: 2.8 days following hospital discharge ■ 440 virtual visits following a procedure; 390 following an admission ■ Significant issues addressed: Neonatal feeding concerns, additional education about upcoming surgery, medications, prognosis, symptom management, ordering interval testing and arranging for home equipment

Specialized programs Fetal Cardiology Program

Program distinctions

Specializing in fetal echocardiography, our cardiologists, as partners in the Fetal Center, 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

Ranked 6th in the nation by U.S. News & World Report ; ranked in the top 10 for four years in a row

24 board certified physicians

See full team member list >

Recognized by U.S. News & World Report as the Midwest’s best hospital for children’s heart care

Results ■ Recognition of critical patient needs

National leader in patient outcomes with mortality rates below benchmark*

■ Appropriate escalation of care, potentially preventing patient harm ■ Opportunity for caregivers to discuss concerns after discharge ■ Synchronized visits with support services (dietary, social work, pharmacy)

Integrated care model with subspecialty care coordination and novel approaches to cardiac intensive care, inpatient navigation and home monitoring

■ Added convenience for patient families Total virtual care visits increased from 873 in 2020 to 1,993 in 2021

41 research publications in 2021

Only accredited comprehensive adult congenital heart disease program in Indiana

National program affiliations and accreditations ■ Pediatric cardiac catheterization and ECHO labs accredited by the Intersocietal Accreditation Commission ■ Member of the Cardiac Neurodevelopmental Outcome Collaborative ■ Accredited by the Adult Congenital Heart Association

Notable research publications Human Genetics and Genomics Advances: September 2021 Identification of a Common Polymorphism in COQ8B Acting as a Modifier of Thoracic Aortic Aneurysm Severity Cardiogenetics: September 2021 A Novel Human Biospecimen Repository for Clinical and Molecular Investigation of Thoracic Aortopathy Metabolomics: October 2021 Metabolic Profiles Identify Circulating Biomarkers Associated with Heart Failure in Young Single Ventricle Patients

* Source: Society of Thoracic Surgeons (STS) Table 16, Harvest Report, published July 2022 for period ending June 30, 2021

Echocardiogram Interpretations: 2016 – 2021 Our program serves more than

Fetal Echocardiogram Volume: 2016 – 2021 Performed at 10 locations across Indiana

40 Indiana hospitals and is achieving record volumes



17,362 17,938 17,887

15,495 16,125


1,647 1,670















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Annual Report 2021



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

Research highlights We follow 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 Fontan procedure) ■ Aortic valve repair 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. 4 publications in 2021

Program distinctions

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. >

Specialized programs Heart Transplant/Mechanical Circulatory Support Program

Ranked 6th in the nation by U.S. News & World Report ; ranked in the top 10 for four years in a row

■ Riley Children’s is one of only 13 programs nationally—and the only program in Indiana—capable of implanting total artificial hearts in children. Aortopathy Program ■ Our heart surgeons partner to provide comprehensive, fully integrated specialty care for disorders of the aorta from the time of diagnosis through adulthood. Fontan Program ■ Comprehensive follow-up program allows patients to see multiple care team members—cardiologists, social workers, dietitians and pharmacists—in one location on the same day.

Recognized by U.S. News & World Report as the Midwest’s best hospital for children’s heart care

3 board certified physicians

See full team member list >

Only pediatric and adult congenital transplant program in Indiana

One of the highest volume centers nationwide for the Ross procedure

30-day Survival: 2019 – 2021

Index operations **

All operations

Seven decades of experience with right ventricular outflow tract reconstruction










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

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

Operative and Adjusted Operative Mortality*






Postoperative Overall Complications Society of Thoracic Surgeons (STS) CHSD Participant Dashboard for period July 1, 2017 – June 30, 2021





STAT Category 1 (Least risk)





No complications identified Riley 68%

STS overall 59%

7/339 4/211

2.06% 1.90% 4.94%

1.60% 1.66% 8.38%

1.37% 1.91% 5.97%

STAT Category 2

STAT Category 3


STAT Category 4 STAT Category 5 (Most risk)

One or more complications identified



13.75% 11.97%

Riley 32%

STS overall 34.8%

Neonates | All STAT Mortality Categories

Observed to expected ratio 0.52





† 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.

* Source: Society of Thoracic Surgeons (STS) Table 16, Harvest Report, published July 2022 for period ending June 30, 2021

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Annual Report 2021

(heart) 317.944.7150 | (lung or throat) 317.944.2394

Led by a team of board certified physicians, the Child Protection Program at Riley Children’s Health offers multidisciplinary clinical services and education to improve the evaluation and care of maltreated children. Our specialists provide 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 PROGRAM

Physical and Sexual Abuse Consultations by Year: 2015 – 2021

6,187 6,028 6,116




Estimated number of children served annually by the Riley Children’s Child Protection Program Child abuse consults 400 Pediatric Center of Hope 500 Crisis counseling 1,500 DCS consults 6,000

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 See full team member list >

Program distinctions

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







Extensive history of collaboration and care coordination with healthcare providers, child protection case managers, law enforcement and the judicial system Consults with the Indiana Department of Child Services (DCS) on about 6,000 cases of suspected child maltreatment each year

Our team is involved in scholarly work addressing disproportionality and disparities in Indiana’s foster care system. We also investigate demographics in child maltreatment evaluation using skeletal surveys as a proxy and employing multicenter trauma databases.

Foster Care Encounters: 2018 – 2021



Our Child Protection Program led 55 community education programs in 2021.

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


Specialized programs Child Abuse Consultation Service




Crisis Counseling Services 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. 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 team facilitates comprehensive medical evaluations for children alleged to have been physically abused or neglected. Foster Care Bridge Clinic 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 Riley child abuse specialists provide comprehensive medical evaluation for children alleged to have been sexually abused.

Research study topics ■ Use of radiography in assessing possible child maltreatment – Chest CT to recognize rib fractures – Differentiation of rickets and classic metaphyseal lesions ■ Evaluation of physical abuse when domestic violence occurs ■ Disparities in evaluation and reporting of drug ingestions by children ■ Impact of screening for child maltreatment in the emergency department ■ Foster parent understanding of adverse childhood experiences (ACEs)

Our specialists are active in many 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 ■ Children’s Policy and Law Initiative of Indiana ■ Local and state child fatality review teams and child advocacy centers

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Annual Report 2021


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