Since its days as a hospital ship in Boston Harbor, Floating Hospital has attracted physicians who are committed to researching pediatric illness and treatments. Today, that commitment to research is more significant than ever, and like our patients, it continues to grow. Floating Hospital has been attracting more researchers at the beginning of their careers; the four researchers highlighted below demonstrate the depth and breadth of the work being done and the great potential ahead.
Tomo Tarui, MD, Director, Fetal-Neonatal Neurology
Tomo Tarui, MD, focuses on ways to more accurately detect early abnormalities in fetal brain development using quantitative fetal brain MRI analysis. His work is funded by an American Academy of Neurology clinical research training fellowship and two private foundations: the Baby Alex Foundation (started by the parents of a child who suffered neonatal brain injury) and the William Randolph Hearst Foundation. Tarui’s research focuses on ways to more accurately detect early abnormalities in fetal brain development using quantitative fetal brain MRI analysis. His work is funded by an American Academy of Neurology Clinical Research Training Fellowship and two private foundations: the Baby Alex Foundation (started by the parents of a child who suffered neonatal brain injury) and the William Randolph Hearst Foundation.
Tarui is “very excited” that he has joined the lab of his research mentor Diana Bianchi, MD, Vice Chair for Research and Academic Affairs and head of the Mother Infant Research Institute (MIRI) at Floating Hospital. He has also continued a collaboration begun five years ago with a radiologist from Children’s Hospital Boston for his fetal neuroimaging research.
“So many diseases have their origin in the fetal and perinatal periods and can affect the baby’s brain development,” Tarui explains. “This is a big public health issue, and we hope to provide new insight into the evolution of brain pathology,” he says of his work.
“Today we can study details of the developing brain using fetal brain MRI analysis,” he continues. “When we detect an abnormality, we can work with the obstetrician to see if we can intervene when the brain is actively developing under the influence of pathology, in order to give the baby a head start. And such knowledge should be passed to the neonatologist and primary care pediatrician so it can help to ensure continuous, seamless care for the baby with neurodevelopmental injury. I myself, as a pediatric neurologist, can follow up continuously after birth to provide continuous support.”
Michael Kelly, MD, MPH, Pediatric Hematology/Oncology
Michael Kelly, MD, MPH, currently has two projects underway to help physicians determine the best treatments and outcomes for children with pediatric leukemia. He was one of two Floating Hospital researchers to be awarded a Career Development Award (KM1) in Comparative Effectiveness Research given by the Tufts Clinical and Translational Science Institute (CTSI) last year in support of his work, which he is conducting in collaboration with his research mentor, pediatric hematologist/oncologist Susan Parsons, MD.
“There is a subset of kids with acute myeloid leukemia (AML) who, based on cytogenetics, are considered favorable, intermediate or poor risk for how we treat this disease, which is either with bone marrow transplantation (BMT) or chemotherapy,” Kelly explains. “There was a big study published several years ago that showed patients with favorable risk did well with either treatment and, in those with intermediate risk, BMT was slightly better. But the number of patients in the poor-risk category was too small to yield any meaningful information.”
“We have international data on several hundred pediatric poor risk AML patients who have been treated with either BMT or chemotherapy over the past 15 years, so we’re currently doing an analysis to compare treatment outcomes among those who received BMT vs. chemotherapy,” he notes.
Kelly’s second project focuses on acute lymphoblastic leukemia (ALL). “When patients relapse, it can occur in either bone marrow or the central nervous system,” he explains. “Historically, patients with a central nervous system relapse have been given prophylactic cranial radiation; it provides protection against central nervous system relapse but puts children at higher risk of secondary malignancies and learning disabilities. Today, there’s a wide variation in treatment approaches, and it’s hard for the clinicians to decide what’s the optimal treatment. So we’re conducting a systematic review of the literature and doing a meta-analysis of survival and outcomes in specifically T-cell patients who’ve received prophylactic radiation compared to those who did not.”
“Both these studies will yield legitimate information regarding the optimal treatment for these patients and address real-life problems in clinical practice,” Kelly adds.
JoAnna Leyenaar, MD, MPH, Pediatric Hospitalist
JoAnna Leyenaar, MD, MPH, one of the Floating’s community hospitalists, is the second Floating Hospital researcher granted a KM1 Award from the CTSI last year. Her comparative effectiveness research is looking at community-acquired pneumonia (CAP) in previously healthy children admitted to hospitals in the United States.
“CAP is the most common cause of hospitalization in this country, yet there is little research about which treatment is most effective for management,” she explains. “At this point, we know there is a lot of variability in how pediatricians manage pneumonia in kids admitted to the hospital, but we don’t know if there’s one optimal way these patients can and should be managed. Our research will help inform this, optimize the care we provide, reduce length of stay, reduce the readmission rate and, ultimately, bring down associated costs.”
Leyenaar is working with her research mentor at Baystate Medical Center, which has access to a large administrative database with information about pediatric CAP hospitalizations at almost 400 institutions throughout the United States. Her research will be critical as Floating Hospital applies evidence-based therapies across its community hospital system to reduce variation in care and to improve clinical outcomes of treatment of children with pneumonia.
Sarbattama Sen, MD, Neonatologist
Sarbattama Sen, MD, is studying the impact of maternal obesity on both maternal and neonatal health, specifically with regard to the increased risk of developing inflammatory diseases such as asthma. She has received multiple grants for her work at the Mother Infant Research Institute (MIRI) at Floating Hospital, the only research institute in the United States that combines pediatrics and obstetrics to investigate the events that occur during pregnancy and their impact on transgenerational health.
“We’re seeing significant immune system impairment in obese women, and we’re looking at how this affects babies as they grow,” Sen says. “What we’re seeing is that children born to obese mothers are more prone to asthma, eczema and disregulation of their immune system. More than half of reproductive-age women are obese or overweight, so we’ve just begun to see the effects of this medical problem. It’s the tip of the iceberg of what we understand.”
“It underscores the very interconnected nature of maternal-child health, and how when the mother is obese, it has profound ramifications on the child,” she adds. “As these children grow, we hope to understand in more detail how maternal obesity during pregnancy affects various aspects of the child’s health.”