Cardiology

The Impact of Nurse-Led QI Projects

In the Children’s of Alabama Heart Center, nurses play a key role in improving outcomes.

In mid-2024, the Children’s of Alabama cardiovascular services team implemented a shift in the way they handled daily rounds. Instead of having attending doctors, fellows, or residents lead them, they decided to put nurses in charge. It was a quality improvement (QI) project that represented more than a process change; it handed the leadership role to the people closest to the patient. And its impact has been significant.

“It makes the most sense,” said Ashley Moellinger, MSN, CPNP-AC, MSHQS, the team’s lead pediatric nurse practitioner, “because [the nurse] knows the patient best, has been with the patient all along.”

Santiago Borasino, M.D., a cardiac intensivist at Children’s, agrees, saying it not only gives the nurse a greater voice, but puts the entire team in a better place. “It actually pushes the team to become a little bit more interdisciplinary where we all have something to say—we all have something to add to the to the plan.”

That’s crucial for the nurse and, by extension, the patient. For young nurses in particular, Borasino pointed out, it’s not always easy to speak up about the patient’s needs when a physician is leading rounds—even though the nurse may understand the needs better.

“Having them present allows them to have the microphone and to be able to say what they want to say,” Borasino said. “They can choose what they say instead of having to interrupt us or correct us or bring up what they think needs to be done when we didn’t say it.”

More than two years after Children’s started the project, which was led by Caitlin Arney, RN, it’s now a core philosophy in the Children’s of Alabama Pediatric and Congenital Heart Center. “It used to be that if the nurse wasn’t at the bedside for whatever reason, we would start without the nurse,” Borasino said. “Now we don’t. The nurse is always there because they’re integral to this concept.”

The nurse’s presence helps standardize the process. “They use a script and a piece of paper, and it’s the same thing every time, whereas when someone else presents, it’s kind of what they think should be shared,” explained Moellinger, who serves as co-director of quality improvement in the Heart Center.

This standardization is one reason the QI project has made a significant impact on the effectiveness of rounds within the Heart Center. According to data gathered by the interdisciplinary nurse-led rounds task force that spearheaded the project, nurse-led rounds have sparked a statistically significant change in discussion of the patient’s history, titration goals for vasopressors, fluid balance goals, respiratory support weaning goals, withdrawal assessment tool scores, state behavioral scale scores, vital sign goals, and rescue medication plan. The group’s report also highlights improved communication among the interdisciplinary rounding team and a boost in confidence among the nurses, some of who were initially skeptical of the new strategy.

“They went from being really sort of anti and not really wanting it to now they love it,” Borasino said.

Moellinger and Borasino have twice presented data on nurse-led rounds at the annual Pediatric Cardiac Intensive Care Society (PCICS) conference. They believe other units within the hospital can use the same strategy to help improve communication and comprehensive discussion of each patient’s condition.

The Impact of Nursing in the Heart Center

Nurse-led rounds is just one of many nurse-led QI projects the Children’s cardiovascular services team has implemented over the last few years. Below are some of most recent ones. While they’re too new to have any significant data yet, they do provide hope for the possibility of improved processes and outcomes, especially in light of the success of past projects. “I would say nothing changes without the investment of those frontline people,” Moellinger said. “You have to have buy-in.”

The projects underscore the pivotal role that nurses play on the Heart Center team. “Nursing is extremely important for our center,” Borasino said. “And the relationships we have with our nurses are an extremely important part of the outcomes that we have and the work and joy that we all have.”

CURRENT NURSE-LED QI PROJECTS

Vital Signs and Parameters

Each patient has their own set of goals, limits, and parameters for their vital signs. In an ideal situation, the care team is discussing these numbers and entering them into the monitors at the patient’s bedside. The process ensures that the patient is staying within the proper range, and it can—through the use of alarms—help the team identify when the patient might be at risk for an adverse event, which would trigger the need for provider intervention. But if the correct numbers are not entered, the alarm may not go off when needed, or it may go off too frequently—creating a white-noise situation where a nurse might develop the habit of reflexively silencing the alarm every time.

To correct this issue, the team originally implemented a QI project in 2019, when alarms were sounding hundreds of times per bed each day, according to Borasino. That project helped to dramatically reduce that number. Now, in a second iteration of the project—led by RNs Abi Capouya, Emily Beach, and McKenna Leahy—the team is taking more steps to ensure that the alarms go off at the right time. Moellinger says the project focuses on ramping up daily discussions about each patient’s vital signs, while also auditing and adjusting processes to ensure that providers are being notified when limits are surpassed. With this latest version of the project, which stared in mid-2026, the team hopes to reduce cardiac arrest rates and identify patient deterioration sooner.

Dual Sign-off Process for Medications

To decrease medication errors, the Heart Center team uses a process called independent double check, which simply means that when administering high-risk medications to a child, two people must independently check that the medication is being administered properly. With the recent installation of new smart pumps designed to help with double check, the process is changing. That’s why the team—led by RNs Haley Cobb, Samantha DeArman, and Yanci Horton—has implemented a QI project to ensure that each step of the new drug administration process, now called dual sign-off, is being taken. This can include following the medication bag to the pump, making sure it’s programmed correctly, checking that the medication is reaching the patient in the correct access port, along with other responsibilities. “We haven’t really had a good step-by-step process for what double check looks like, which has made the compliance low,” Moellinger explained. “And especially now that we have these new pumps, there’s going to be a different process because you electronically sign off or hand off the drug together with a signature in the [electronic medical record].”

“We’re really trying to focus on and hone in on that process itself to help with medication errors,” she added.

Emergency Simulation

When an emergency arises in the Heart Center, preparation is crucial. Everyone on the team needs to know how to respond. That’s why leaders recently implemented a QI project in collaboration with the Children’s Pediatric Simulation center for training. “We’ve really started pushing into a lot of different areas and using simulation to help everybody get more comfortable with those emergent situations,” Moellinger said.

Missy Britton, CRNP, and Matt Clark, M.D., have led the effort alongside Sara Ewert, a nurse educator in the Simulation Center. One recent training simulated an emergency involving a patient on a ventricular assist device in a CT scanner, requiring multiple disciplines to respond.

In the Cardiac Care Unit (CCU), the team has also worked on response time to emergencies and the various responsibilities that come along with those, such as getting defibrillator pads on a patient, drawing up emergency drugs, administering drugs, recognition of deterioration, and administering bedside epinephrine.

“They’ve been doing a lot of one-on-one education, which is not really with the sim lab, but they’re simulating events in short segments to really work on all those responses,” Moellinger said.

Goals and Other Projects

With each of these nurse-led QI projects, the primary goals are improvement and sustainability. Eventually, leaders want the new processes to assimilate into the culture of the unit. Many previous projects have achieved that level of success, giving Moellinger and Borasino the hope that the newer projects will also become accepted standards.

August 5, 2026 by
Gastroenterology

Revival of Split-Liver Transplant Program Expands Access to Organs

Marcos Pozo Jatem, M.D. (left), and Saulat Sheikh, MBBS (right), performed a split-liver transplant in the fall of 2025.

By Charles Buchanan

Infants and children needing liver transplants face a unique challenge: The number of available donor organs, which is already limited, dwindles even further for them because most donated livers are simply too big to fit their small bodies. That can mean a long wait for a transplant and greater frustration for families.

Now Children’s of Alabama and the University of Alabama at Birmingham (UAB) are collaborating to offer split-liver transplantation, a potentially game-changing, life-saving solution for these young patients. Split-liver transplantation is “an opportunity to help two patients with one organ,” said Stephanie Saaybi, M.D., a pediatric gastroenterologist at Children’s who is part of the liver transplant team. During the complex procedure, one liver from a deceased donor is divided between two recipients, with the smaller left lobe usually going to a pediatric patient while the larger right lobe is reserved for an adult patient. Each segment grows along with its recipient and serves as a normally functioning organ, Saaybi said.

In the fall of 2025, surgeons from Children’s and the UAB Division of Transplantation successfully performed the intricate operation for the first time in nearly a decade. Fewer than 50 medical centers in the United States offer split-liver transplantation, and Children’s, partnering with UAB, is the only one in Alabama. Reviving the procedure is both a major milestone and an important step toward expanding access to donated organs for infants and children on the liver transplant waitlist.

Split-liver transplantation also helps fulfill a need for more treatment options for more patients with liver diseases. “We want to serve the whole spectrum of acuity and severity,” Saaybi said. According to the American Liver Foundation, approximately 15,000 children across the country are hospitalized for liver diseases annually. About half of pediatric liver transplants result from biliary atresia, a condition in which blocked ducts cause bile to build up in the liver and damage it, Saaybi explained. Other frequent diagnoses in the Children’s liver transplant program, which receives referrals from across Alabama and neighboring states, include acute and chronic liver failure causes such as genetic disorders, autoimmune liver disease, cholestatic disease, metabolic dysfunction-associated liver disease, and liver malignancies such as hepatoblastoma, among other conditions.

Split-liver transplantation is rare because planning and orchestrating each one is a logistical feat. For the 2025 procedure, the donor operation took place in another state, and the liver segments were transplanted into recipients at both Children’s and another institution, as determined by the national transplant allocation program and surgeons. A successful outcome depends upon precise timing and coordination of several operations at different hospitals and the contributions of a multidisciplinary, multi-institutional medical, nursing, and administrative team. Saaybi is one of two pediatric gastroenterologists specializing in transplant hepatology who are part of the Children’s/UAB partnership, along with surgeons, coordinators, anesthesiologists, nephrologists, interventional radiologists, and pediatric intensive care unit staff. Because transplant surgery impacts every aspect of life—for the patient’s entire life—the team also includes pharmacists, dietitians, social workers, child life specialists, psychologists, and even a school liaison. Marcos Pozo Jatem, M.D., a transplant surgeon, leads the Pediatric Liver Transplant Program at Children’s.

A core group of specialists representing the larger team meets regularly to coordinate each patient’s evaluation, transplantation surgery, and postoperative care through the transition to adult care. “Our discussions give us opportunities to learn from one another and explore ways to better serve patients,” Saaybi said. For example, the group implemented an intraoperative dialysis protocol so that they could perform transplants in critically ill patients—a project that has improved care and yielded positive outcomes, she added. The specialists also standardized their immunosuppressive protocols and continue to review and revise guidelines and procedures as needed.

Another advancement critical to the success of split-liver transplantation is the use of machine perfusion technology, which pumps blood continuously through the donated liver and lengthens the amount of time the organ can stay alive outside the body. As a result, Children’s and UAB can accept a donated liver from anywhere in the country while reducing its exposure to cold storage, thus preserving the organ’s viability.

With the team, expertise, and technology in place, split-liver transplantation at Children’s and UAB is poised to help more infants and children stop waiting and start thriving. “We initially see patients at their most vulnerable,” Saaybi says. “It’s humbling to be with them through the whole continuum of care, and a blessing to watch them change and grow—to get them to the point where they talk about things like playing baseball or going to college. This is their new chance at life.”

August 5, 2026 by
Endocrinology

Could GLP-1 Break the Insulin-Obesity Cycle in Type 1 Diabetes?

Children’s endocrinologists are taking a closer look at how GLP-1 can help T1D patients. (Stock photo)

By Charles Buchanan

Over the course of a century, insulin has become the foundation of diabetes treatment, saving countless lives and transforming the fatal disease into a manageable chronic condition. Yet a majority of people with type 1 diabetes (T1D)—80%, according to Giovanna Beauchamp, M.D., a pediatric endocrinologist at Children’s of Alabama and the University of Alabama at Birmingham—still struggles to achieve optimal glycemic control with insulin alone.

GLP-1 receptor agonists, a therapy originally developed for type 2 diabetes (T2D) that has become a popular weight-loss aid, could provide a solution. In the past few years, a growing number of pediatricians and endocrinologists have prescribed GLP-1 along with insulin for T1D and reported promising outcomes. Beauchamp and Ortal Resnick, M.D., a pediatric endocrinology fellow at Children’s, recently published a review of clinical research that details GLP-1’s impact and offers hope that more patients may be able to take charge of their disease.

Weight Control for Diabetes Control

Maintaining a healthy weight and achieving good diabetes control are difficult even with technology such as insulin pumps, continuous glucose monitors, and automated insulin delivery systems—because the challenge is insulin itself, Beauchamp said. The anabolic hormone causes people with T1D to gain weight, setting off an escalating cycle of complications.

In fact, about 60% of people with T1D are considered overweight or obese, Resnick said. “On average, a patient that starts on insulin treatment gains five kilograms in the first five years of treatment. So we know the treatment by itself causes weight gain.”

Resnick
Beauchamp

Overweight and obesity also are increasingly common in people with T1D at the time of diagnosis, which shows that the traditional stereotype of T1D as a disease affecting only lean individuals is not entirely accurate, Resnick explained. Obesity, associated with increased inflammation in the body, may contribute to triggering or accelerating autoimmune processes in people who are genetically predisposed to developing T1D.

That additional weight also increases insulin resistance, which means that patients need more insulin, which leads to more weight gain—and then the loop begins again. Round after round, the stakes get higher, eventually spiraling into obesity that sparks inflammation and further destruction of beta cells. Severe diabetes, threatening damage to the heart, kidneys, eyes, and other organs and tissues throughout the body, can set in early.

GLP-1 therapy provides an off-ramp from the worsening cycle. Formally known as glucagon-like peptide-1 receptor agonists, the medications are based on the body’s natural GLP-1 hormone, which affects insulin secretion and helps us to feel full after we eat. Prescribing them as a therapy efficiently ramps up both processes, as seen in patients with T2D who have benefited from GLP-1’s improved glycemic control and weight loss over the past two decades. In T1D, just as in T2D, GLP-1 curbs the appetite and makes insulin more effective. Eating less leads to weight loss and reduced doses of insulin.

Research Review

For their research review, Beauchamp and Resnick analyzed results from about a dozen clinical trials of GLP-1 in patients with T1D. They compiled evidence about the medication’s effects on weight and HbA1c, an individual’s three-month average amount of blood sugar, among other measures.

Their findings revealed that adding GLP-1 led to consistent weight loss across all the trials, and most participants were able to lower their insulin doses. HbA1c improved around 0.3%, a small number that nevertheless has significant meaning for patients because it indicates better glycemic control, Resnick said. “The fact that they’re losing weight and their total daily insulin is decreased . . . is a big outcome that we think will affect their long-term complications.”

Beauchamp agreed. “The best way that we are going to see improvement in those potential complications is by improving glycemic control and with weight management. By helping with weight loss and consequently decreasing the amount of insulin that our patients will need, the rate of diabetes-related complications should decrease.”

Maintaining Glucose Balance

Naturally, physicians may be wary of reducing insulin because of the chance it could disrupt patients’ glucose balance and push them into hyperglycemia—high blood sugar. Beauchamp and Resnick investigated that potential outcome and found that, in the studies they reviewed, adding GLP-1 and decreasing insulin resulted in fewer instances overall of hyperglycemia and diabetic ketoacidosis, a severe insulin deficiency requiring intensive care. As for hypoglycemia—low blood sugar—the risk exists, but endocrinologists can carefully monitor and manage the balance between the two medications in response to each patient’s weight loss and decreased insulin need, Resnick said. Patients should continue to eat enough for healthy nutrition, and following a balanced diet is essential. Otherwise, “very easily, you can become malnourished if you decrease your appetite and eat only nonnutritional food,” she said.

The most common side effects of GLP-1 that Beauchamp and Resnick identified in their review were nausea and vomiting, the result of the medication slowing the process of gastric emptying. People who experience this are often used to eating big meal portions, Resnick said. Consuming smaller portions and decreasing the meals’ fat content helps reduce nausea and vomiting, as does increasing the dose of GLP-1 at a slower, more gradual pace, she added.

A Treatment for Life?

Another key question on the minds of many physicians: What are the health implications of taking GLP-1 long term? Beauchamp noted that GLP-1 likely would be a lifelong treatment, alongside insulin, because of its benefits in helping patients with T1D control obesity and reduce their risk for related complications. However, she emphasized that researchers currently don’t have enough data to say for sure.

“We need more time, and we need more research,” Beauchamp said. That actually was one of the crucial takeaways from their review of previous work—that more studies are needed. So far, only a few trials have focused on GLP-1 specifically for T1D, and most used an older version that was administered daily, now superseded by a stronger weekly formulation. And no existing study has followed patients early enough in the course of their disease to observe whether the medication can preserve some beta-cell function.

Still, “we have been using GLP-1 for T2D for about 20 years now [and] from what we know . . . it’s pretty safe,” Resnick said. Patients also don’t receive the same amount of GLP-1 forever, she added. Once the initial dose helps them lose weight, patients are prescribed smaller doses to help them maintain their target weight.

Beauchamp hopes that more pediatricians and endocrinologists will become comfortable using GLP-1 for T1D. Personalizing the therapy for each patient is the key to navigating potential challenges, she said. “Those of us who have used it for patients with T1D and obesity, we see wonderful benefits. I think they are all very pleased with those results, which then lead to better diabetes control, [an] overall better outlook in life, and being able to live a healthy and happy life.”

To learn more about the research Beauchamp and Resnick are doing on GLP-1, check out this episode of the Children’s of Alabama PedsCast.

July 30, 2026 by
Behavioral Health

A statewide network for parent-child interaction therapy

Arista Rayfield, Ph.D., (middle) and the Children’s behavioral health team hosted a PCIT conference in March 2026.

When Ashley Pittman, LPC, signed up for parent-child interaction therapy (PCIT) training at Children’s of Alabama in 2023, she had no idea what to expect. Even after earning her certification, she realized it was like no other therapy she had offered. But an experience with one of her first PCIT clients was a revelation.

“At first, I was… a little bit out of my comfort zone,” she said. “But then I started to see results, and I started to recognize just how beautiful it was.”

Pittman is a licensed professional counselor in Enterprise, a small, rural city in south Alabama. Since her training, she’s seen many PCIT clients, including one who had a profound impact on her view of the therapy, which helps to correct moderate-to-severe behavioral problems in young children by teaching the parent and child how to interact effectively. During one of the sessions, the mom began to cry. “It was a very beautiful moment where she was truly connecting with her kid,” Pittman recalled. “And she told me that she felt that she had never been able to do that, did not know how to do that, and that she herself probably never felt connection with her own parents.” For Pittman, the moment was eye-opening.

“It came alive within me that there was beauty in what was happening with PCIT that I just fell in love with and became very passionate about,” she said.

Pittman says moments like this happen frequently with her PCIT clients, who make up about two-thirds of her business. And they’re likely happening with other counselors and clients across Alabama thanks to Children’s of Alabama’s commitment to training providers like Pittman.

How PCIT works

Shelia Eyberg, Ph.D., developed PCIT at the Oregon Health Sciences Center and later refined and researched it at the University of Florida. She designed it as a way to treat disruptive behavior disorders in young children. These behaviors can include tantrums, refusal to follow directions, aggression, and problems in school. For families experiencing these problems, a therapist trained in PCIT can determine if it is the right fit.

Ashley Pittman, LPC

PCIT works by allowing the therapist to monitor and coach a series of playtime interactions between the parent and child. It is conducted in the play setting because that is how young children learn best. This happens in two phases: Child Directed Interaction (CDI) and Parent Directed Interaction (PDI). In CDI, the therapist teaches the family skills that a play therapist would use. In PDI, the therapist teaches parents how to be consistent and predictable to improve how children follow their directions. Then, during the interactions, the therapist watches from another room, usually behind a one-way mirror, and coaches the parent using a wireless earphone. Families typically complete PCIT in 12 to 16 weeks, and the results can be transformative.

“It has a huge impact,” said Arista Rayfield, Ph.D, who learned the therapy under Eyberg and serves as the PCIT service line leader at Children’s. “Behavioral problems are decreased. Parent-child relationships are improved and are very warm, supportive relationships. Parents quit getting calls from teachers. That is a big improvement.”

Coaching is what makes PCIT uniquely effective. “We are teaching [parents] the skills, and so we try to focus on when they’re getting it right: ‘We want to see more of this. You’re doing a great job following their lead,’” Rayfield said. “So, we’re really trying to focus on what the parent is doing well and help them make the changes sometimes that are pretty small and you’re not aware of unless someone is observing you and helping give you feedback on your interactions.”

This observation gives the therapist an up-close view of the child’s progress. “It’s wonderful working with young children because you see the changes happening in the moment,” Rayfield said. “I see the techniques working within the very session that we are in. I see children making changes based on how the parent is interacting with them.”

Training Other Therapists

Rayfield has been training parents on how to interact with their children for 35 years, but in 2022, she, her Children’s colleagues, and two other University of Florida graduates—Elizabeth Brestan-Knight, Ph.D., and John Paul Abner, Ph.D.—began training other therapists in Alabama on how to perform PCIT. The trainings are possible through a partnership with the Alabama Department of Mental Health (ADMH) and are supported by two grants, the Pediatric Access to Telemental Health Services (PATHS) grant and the Promoting Positive Early Experiences and Relationships (PPEERS) grant. So far, the group has trained 69 therapists across 21 Alabama counties to provide PCIT.

“That has made a huge difference in access for children across our state. Everybody can’t drive to Birmingham to get treatment,” Rayfield said. “That means that families can get access to treatment without a long wait list and closer to their home.”

Rayfield and her team have also trained several providers across the state to become within-agency trainers, meaning they can train others within their own agency on how to perform PCIT. This multiplies the number of PCIT-certified therapists statewide.

In March, Children’s and ADMH hosted a PCIT continuing education conference for the therapists they have trained, those in the process of training, and others who might be interested. “There’s a wonderful community internationally with PCIT, and we’re trying to build that in our state to help people feel supported and to be able to continue to provide this therapy for young children,” Rayfield said.

But Rayfield’s influence doesn’t end at the state line. In 2025, she became a regional trainer through PCIT International. She’s one of only about 50 such trainers nationwide.

Children’s investment in PCIT

In the last five years, Children’s has ramped up its investment in PCIT. In addition to the training the behavioral health team has provided across the state, they’ve also added more PCIT-certified providers within their department and built a space specifically designed for PCIT. The goal is to increase access for children across the state. Simply offering PCIT can help achieve that. Rayfield says the therapy is designed to help the child graduate the program so they no longer need therapy, which frees up space for more children who need help—more children who can be served by the growing network of PCIT providers Children’s is developing throughout the state.

July 29, 2026 by
Cardiology

A bridge to better outcomes

The bridges that connect UAB and Children’s of Alabama play a key role in the Bridging the Fetus collaboration.

Among the crucial features of Children’s of Alabama’s Benjamin Russell building, which was added to the hospital’s campus in 2012, is a set of bridges that connect Children’s to the University of Alabama at Birmingham (UAB) Hospital. The two institutions have worked in partnership for decades, and the building and adjoining bridges further enhanced the relationship. Specifically, they allowed for patients to be transported efficiently from one hospital to the other when necessary for care. A collaboration called Bridging the Fetus takes advantage of this arrangement to help patients with congenital heart disease. It’s helped save many lives, even in some of the most dire situations.

The collaboration involves the Children’s cardiovascular ICU team, cardiologists, cardiac surgeons, UAB’s Maternal-Fetal Medicine team, and neonatologists. And the bridge, of course, which is perhaps the program’s most unique feature.

“The setup we have with the bridge is a big deal for us because it allows us to best take care of moms but also best take care of babies by being so close,” said Laura Brasseale, MSN, CRNP, chair of the Children’s cardiac fetal team.

Laura Brasseale, CRNP

Proper care for both the mom and baby is vital in these cases because many of the congenital heart diseases the team handles are identified prior to birth. Thus, the team must have a detailed plan in place for delivering the baby at UAB, then getting it to Children’s for care while the mom remains at UAB. Thanks to the bridge that connects the UAB Women and Infants Center to the Children’s Heart Center, the transfer can happen in mere minutes. As a result, Children’s and UAB have taken referrals from other parts of the Southeast in these cases where, in another city, the delivering hospital might be 20 minutes or farther away from the Children’s hospital. “It is very unique to our situation that we have all these resources literally connected to each other,” Brasseale said. Few other hospitals in the Southeast offer this type of setup.

The collaborative effort of Bridging the Fetus begins as soon as a patient is diagnosed with a congenital heart disease. Brasseale follows each case and takes information from the mom’s clinic visits with obstetricians and cardiologists. She uses this info to compile a list with data to help the team plan for the delivery. Before the baby is born, the team provides advice and counseling for the parents. They also arrange logistical services, such as transportation assistance, long-term stay options and other resources. Lactation specialists meet with the mom to discuss feeding options and the importance of breast feeding. Palliative care assists with end-of-life decisions, if necessary.

From the time the diagnosis is made, members of the team meet regularly to discuss details of the case and form a plan of care for the child’s delivery. “It just makes us aware so that we save beds for these neonates,” Brasseale said. “We get them transferred over from [the UAB Regional Neonatal Intensive Care Unit] as soon as possible so that we can plan their next steps after birth.”

Typically, the next steps involve taking the child across the bridge to be seen immediately by the heart team and undergo and operation shortly thereafter. The mother, meanwhile, remains at UAB to be cared for at the Women’s and Infants Center.

Cases like these are highly complex, Brasseale said. And the biggest challenge is the simple fact that no one knows when the baby will arrive. But Bridging the Fetus streamlines that for everyone. “We plan according to your due date, according to whether mom has any pre-existing conditions, whether she’s had other children before, where they live. All of that plays a factor in terms of how we plan for delivery on these babies.”  

Because of the planning, the team will know if the baby needs immediate care or if they can stay in the NICU for a few hours until a bed opens up. “It’s definitely a good heads up and provides a multidisciplinary approach for the family,” Brasseale said, “because Maternal-Fetal Medicine can refer them to genetic counseling and the neonatologist so the family can meet a wide variety of people before having the baby. So it can kind of calm nerves as far as that goes.”

The team also prepares the family by giving them hospital tours beforehand so they’ll get “an up-close look of who is going to be taking care of their baby and what their baby’s future looks like,” Brasseale added.

The most notable success stories owed to Bridging the Fetus involve babies with hypoplastic left heart syndrome with intact atrial septum. Babies with this condition lack intracardiac shunting, so oxygenated blood can’t reach the body. Most require immediate extracorporeal membrane oxygenation (ECMO) cannulation after birth to increase the chance of survival to palliative surgery.

Children’s and UAB have seen four such cases since they started Bridging the Fetus in 2016. Three of the babies were cannulated onto ECMO within 15 minutes of birth. Two had successful heart transplants. The results far exceed those at other centers, Brasseale says, and it’s due to the team’s coordinating and multidisciplinary approach. Just getting everyone on the same page has a complexity of its own, with multiple service lines involved and each one featuring 10-20 people with rotating on-call schedules. “There are so many players. I think that’s the biggest part,” Brasseale said. “So it’s just nice for the information to all be in one place considering there’s so many different people who need to be involved.”

The team also is participating in research related to its work with Bridging the Fetus. One study is taking a look at how delayed cord clamping among neonates with congenital heart disease can effect neurodevelopmental outcomes. Another is a collaboration with the Pediatric Cardiac Critical Care Consortium (PC4) and aims to advance understanding of the maternal-fetal environment and its influence on postoperative outcomes in children with congenital heart disease. “The role of maternal characteristics in postnatal outcomes is a major knowledge gap in the treatment of congenital heart disease,” Brasseale said. “Identifying these prenatal risk factors is the first step toward developing therapeutics to modify them.”

The team hopes these studies will pave the way to a better understanding of these highly complex neonates, which can only help further streamline their care and produce more positive outcomes.

“It’s really cool to see the team come together to provide the best care for the patient, because it’s a lot of different people from a lot of different disciplines and even hospitals,” Brasseale said. “But it’s very exciting to see a baby thrive that was really not destined to have a good outcome. So it’s very exciting to be a part of such a big team.”

July 29, 2026 by
Pulmonology

Teaching youth about the dangers of vaping

More than 5% of all middle- and high-school students say they use vaping devices. (Stock photo)

When Children’s of Alabama pediatric pulmonologists Isabel Lowell, M.D. and Brett Turner, M.D. speak to kids or their parents about vaping—which remains prevalent in middle- and high-school students despite a simultaneous decline in cigarette smoking—they continually find themselves battling the misconception that vaping is somehow safer.

Social media and advertisements for vapes, which are marketed in hundreds of teen-tempting flavors, have convinced kids that vaping isn’t the major health threat it is. But Lowell and Turner vigorously dispel such myths as part of a Youth Tobacco Prevention Program run in partnership with the Children’s of Alabama Tobacco-Free Task Force.

Brett Turner, M.D.

According to the U.S. Food and Drug Administration’s National Youth Tobacco Survey, about 5.2% of all middle- and high-school students say they use vaping devices, and 27.5% of those say they use these products every day.

“We’re uniquely positioned to take this on, since it’s an issue that affects both patients and families,” said Turner, who’s also the medical director of Children’s Respiratory Care Services and an associate professor of pulmonology at University of Alabama at Birmingham (UAB).

“This has been a very important part of how we provide education about vaping not only to kids in the community, but the Department of Pediatrics and the Division of Pulmonary Medicine,” added Lowell, who’s the medical director of Children’s Pediatric Pulmonary Care Unit and a professor of pulmonology and sleep medicine at UAB.

Lowell and Turner took over the program two years ago. Funded by a grant from the Alabama Department of Public Health, it involves several goals, including:

  • Teaching about the dangers of vaping to at least 1,000 students in grades 5 through 12 in Birmingham and the surrounding areas.
  • Providing anti-tobacco and vaping information at four or more community events.
  • Working with students at local middle schools and high schools to train them on vaping and facilitate their ability to lead peer-to-peer presentations.
  • Conducting 10 community adult presentations on the dangers of smoking and vaping.
  • Creating social media content on vaping to post on Alabama Department of Public Health social media sites.
  • Providing material and resources on vaping to school nurses and counselors, as well as answering questions.
  • Conducting assessments of vape and cigarette advertising at local gas stations and other retailers who sell vapes.
Isabel Lowell, M.D.

Independently of the grant, Lowell and the Pulmonary Asthma Team are surveying adolescents at Children’s severe asthma clinics on the use of vapes and cigarettes, as well as second-hand exposure. While anyone who vapes is exposed to many toxic chemicals that can damage and inflame airways and compromise the immune and cardiovascular systems, “in kids, there are harmful effects on the brain, affecting learning, impulse control, and mood,” Lowell said. “Vaping can also be especially dangerous for children with underlying lung disease.”

“We often see adolescent patients struggling to compete at the same level sports-wise as they had, feeling like they can’t take a deep breath,” Turner explained. “As we dig deeper into their social habits, we discover they’re vaping and that the timing of their respiratory symptoms aligned with when they developed chronic vape use.”

During their school presentations, Lowell and Turner also dispel the popular misconception that using nicotine boosts mood. In contrast, it “becomes something that drives more worry and fear and mood swings,” Turner said.

Students seem very open to the program’s message, Lowell and Turner say, and they plan to continue the program as long as funding remains. “We also provide them with resources to quit,” Lowell added. “If they’re vaping, they know there’s help out there, and people and programs they can go to that will help them without punishment.”

July 29, 2026 by
Neonatology

Research reveals optimal approach for patent ductus arteriosus

An X-ray shows a patent ductus arteriosus (File photo)

Doctors have long debated whether very premature babies with patent ductus arteriosus (PDA)—a cardiac condition where a blood vessel that normally closes shortly after birth remains open, stressing the heart and lungs—should be immediately treated with medication to close the vessel, or whether it’s better to wait and see if the vessel closes on its own.

Compelling new research by Children’s of Alabama neonatologist Waldemar A. Carlo, M.D., reveals important answers. Along with researchers from 32 other hospitals across the United States, Carlo sought to learn whether simply monitoring infants and intervening only if needed, compared with actively treating PDA, improves survival or reduces serious lung problems.

Results of the study, published last December in JAMA, surprised even Carlo. Monitoring infants and intervening only if needed, rather than treating the PDA up front, improved survival or serious lung problems—the main outcome—with the rate of developing bronchopulmonary dysplasia (a serious chronic lung disease) essentially the same in both groups. Notably, however, babies in the watch-and-wait group were significantly more likely to survive: 4.1% of infants in the expectant management group died, compared to 9.6% of those in the medication treatment group.

Waldemar Carlo, M.D.

“I don’t think anyone was expecting to see such a large difference in mortality,” said Carlo, who’s also the Edwin M. Dixon Professor of Pediatrics and director of the Division of Neonatology at the University of Alabama at Birmingham (UAB).

PDA is the most common cardiovascular condition in preterm infants, and Children’s clinicians monitor or treat about 100 babies with the condition each year. Occurrence of PDA jumps to more than 50% for extremely premature infants such as the 482 included in the study, who were all born between 22 and 28 weeks of pregnancy.

“PDA tends to be present in the sickest premature babies with the worst outcomes, which is why there has been a lot of interest in closing the PDA,” Carlo says. “But the data have been controversial on whether these babies need treatment or not.”

A small PDA might cause no symptoms and resolve on its own. Larger ones can lead to a variety of dangerous complications, including rapid breathing or shortness of breath, poor feeding, failure to thrive, fatigue, and frequent respiratory infections. In the study, which was carried out as part of the National Institute of Child Health and Human Development Neonatal Research Network, expectant management proved superior to all medications or other approaches used in babies randomly assigned to active treatment, including acetaminophen, ibuprofen, or indomethacin as well as surgery.

“Treatment to close the patent occurred in both groups, which is mimicked in clinical practice,” Carlo said, “and none of the treatments really had a benefit. The study design was pragmatic and easy to implement. It can help clinicians in a practical way.”

The trial reinforced how neonatologists at Children’s have long managed PDA, Carlo noted, but participating in such a high-profile, comprehensive effort benefits everyone involved.

“Our patients can take advantage of state-of-the-art care through randomized, clinical trials and innovative inventions. The trial is funded by the government, and the government benefits because we find out what are the right treatments in these patients,” Carlo said. “It’s a win-win situation.”

July 29, 2026 by
Hematology and Oncology, Orthopedics

Combining two specialties, Hess plays unique role at Children’s

Matthew Hess, M.D. specializes in pediatric and adult orthopedic surgical oncology.

After witnessing his beloved drum teacher cope with sarcoma, Matthew Hess, M.D., knew starting in high school he wanted to someday work in oncology. That fraught life stage also brought a variety of orthopedic injuries that piqued Hess’s interest in orthopedics. Then he learned he could combine the two specialties by performing orthopedic surgery on children and adults with cancer.

The result has benefited patients at Children’s of Alabama. Hess, who came to Children’s in September 2024, is the only specialist in Alabama who’s trained in both pediatric and adult orthopedic surgical oncology.

The conditions Hess tackles are fairly uncommon, he notes, attracting only about 20 new fellows nationwide to his dual specialty each year. In children, he most often treats osteosarcoma, Ewing sarcoma, and non-cancerous tumors that are locally aggressive and threaten to destroy bone. In adults, Hess usually sees patients with metastatic cancer that has spread to bone and requires surgical stabilization or reconstruction.

Also an assistant professor of orthopedics at the University of Alabama at Birmingham (UAB), Hess—who earned his medical degree from the UAB Heersink School of Medicine and spent his residency at UAB Hospital—was thrilled to come back into the fold by joining Children’s.

“I had some faculty members who put teaching and mentorship at the forefront of practice and inspired me to want to do that for the residents around me,” he said. “The thing that stood out to me was that they were extremely collaborative.”

Hess is using that example well. His role requires extensive collaboration with a wide variety of other highly trained physicians, including medical oncologists, pathologists, and musculoskeletal radiologists. Children’s and UAB also boast a cross-institutional collaboration group designed for adolescent and young adult (AYA) patients—those ages 15 through 39—in which Hess features prominently because of his skillset.

“AYA patients exist right in the middle and can get a little lost in translation—do we treat them like an adult, or like a kid?” Hess said. “Osteosarcoma in particular is pediatric, but we see it a lot in teenagers and college students, who are trying to start to be adults. I tend to be the one who helps facilitate which team they end up seeing.”

While there’s some overlap between the way pediatric and adult orthopedic oncology patients are treated, children have certain unique considerations, Hess noted—“namely, a long life ahead. Sometimes you can make different decisions for someone who’s 70 years old versus someone who’s 7,” he said. “Mostly it comes down to how we choose to get rid of the cancer and keep their limb functional.”

What Hess enjoys most about his role is the continuity of care. Ideally, pediatric sarcoma patients who undergo successful surgeries—often living with metal implants in a limb—need a specialist to monitor and treat them through many decades. Hess is happy to oblige.

“I have patients who had surgery with another surgeon 20 years ago and are now 35, and we’re doing revision surgery together to keep them walking and fully ambulatory,” he said. “You’re the continuity person for these kids when they become adults, because the cancer is gone but they’re still dealing with the repercussions.”

“Every orthopedic oncologist goes into the specialty with the dream of seeing the kids they treated in their first years of practice come back someday having had their own kids,” Hess added. “I don’t think you get to do that in most medical specialties. It’s very exciting.”

July 28, 2026 by
Endocrinology

Helping Teens with Diabetes Move to Adult Care

Christy Foster, M.D., leads a new clinic that helps prepare adolescents for the transition to adult care.

For adolescents with diabetes, moving from pediatric to adult healthcare can be one of the most vulnerable periods in disease management. Studies have shown that gaps in care often occur during this transition, increasing the risk for complications such as worsening glycemic control and diabetic ketoacidosis.

To address this challenge, Children’s of Alabama recently launched the Bridge Clinic, a dedicated program designed to help adolescents and young adults with type 1 and type 2 diabetes gain the skills and confidence needed to successfully navigate healthcare independently.

The clinic, which officially began seeing patients this spring, provides a structured, multidisciplinary approach to transition planning for patients beginning at age 16 and continuing through their move to adult endocrinology providers.

“We really want to help patients build confidence over a couple of years before they leave pediatric care,” Christy Foster, M.D., assistant professor in the Division of Pediatric Endocrinology and physician in the Bridge Clinic, said. “Our goal is to partner with them so that transitioning into adult healthcare doesn’t feel abrupt or overwhelming.”

The idea for the clinic grew out of a healthcare transition workgroup that has spent several years refining educational tools and identifying ways to improve continuity of care for adolescents with diabetes. Although transition topics are already incorporated into routine endocrinology visits, Foster says the Bridge Clinic offers an opportunity to explore those issues more intentionally and in greater depth.

Patients in the Bridge Clinic continue seeing their primary endocrinologist every three months, while alternating visits with the clinic approximately every six months. During those visits, they work with a multidisciplinary team that includes physicians, diabetes educators, dietitians, and social workers.

One of the clinic’s distinguishing features is its encouragement of adolescents to take a more active role in their own healthcare. Patients are asked to spend at least part of their visits independently with providers, allowing them to practice discussing concerns, asking questions, and making decisions about their diabetes management in a familiar and supportive environment.

“We’re trying to create a safe place where patients can gain skills for navigating the healthcare system while still having the security of their family being involved if needed,” Foster said.

For many patients diagnosed in early childhood, this may be the first time they are expected to discuss concerns directly with their provider, describe their medications, or discuss adjustments to insulin doses without relying on a parent.

The clinic also focuses heavily on practical life skills that become increasingly important as teenagers gain independence. Topics include learning how health insurance works, understanding prescription costs, requesting medication refills, navigating college life, driving safely with diabetes, and managing alcohol use.

Rather than simply providing information, the Bridge Clinic emphasizes hands-on learning.

Patients may be asked to complete “scavenger hunts” between visits to determine the out-of-pocket costs of medications, practice refilling prescriptions, or explore insurance options available through college, employment, or other coverage plans. The team then reviews those experiences during follow-up visits and helps troubleshoot any challenges.

Social workers collaborate closely with families to discuss changes that often accompany young adulthood, including moving into dormitories, entering the workforce, or transitioning to a different insurance plan. Dietitians address healthy habits and nutrition concerns that become more relevant as adolescents begin making more independent choices.

Another key objective of the clinic is to reduce the number of patients who lose care during the transition from pediatric to adult endocrinology.

“We know from the literature that this is a high-risk period for gaps in care,” Foster said. “Anything we can do to help prevent that gap and maintain continuity has the potential to make a meaningful difference.”

As patients approach adulthood, the Bridge Clinic team helps identify an adult endocrinologist, prepares a transition summary letter, and guides patients through establishing care with a new provider.

The clinic currently has the capacity to see approximately 30 patients per session and serves a population of more than 800 patients aged 16 and older with type 1 or type 2 diabetes.

Although the program is still in its early stages, Foster hopes it will become an important resource for families seeking additional support during a period that can feel daunting for both patients and parents.

“This is really about giving young people the opportunity to practice being successful adults with diabetes,” Foster said. “If we can help them gain knowledge, confidence, and independence before they leave pediatric care, we’ve given them a stronger foundation for lifelong health.”

July 28, 2026 by
Urology

Boswell leads effort to adopt minimally invasive approach for primary obstructive megaureter

Timothy Boswell, M.D., is one of the nation’s experts on primary obstructive megaureter treatment.

For about 80% of infants with primary obstructive megaureter (POM)—a relatively rare congenital condition in which the ureter is abnormally narrow where it enters the bladder, hindering urine flow—the problem resolves without treatment as the baby grows. For the rest, open surgery has long been the standard approach.

Children’s of Alabama pediatric urologist Timothy Boswell, M.D., is trying to change that. Inspired by European research on, and relatively widespread use of, a minimally invasive technique called high-pressure balloon dilation (HPBD) on children with POM, Boswell is leading the charge to make the option more common in the United States. By doing so, he hopes to minimize pain and other surgical complications for these children.

He and Children’s colleagues have been offering this minimally invasive treatment to the small number of patients needing intervention for POM. HPBD is an endoscopic technique that uses a high-pressure balloon to stretch the narrowed section of the ureter, and it can be a highly successful first-line intervention.

Open reconstructive surgery, called ureteral reimplantation, involves removing the narrow segment of the ureter and reattaching it to the bladder so urine can flow freely. An interim procedure called a ureterostomy can redirect the ureter to a stoma in the abdomen, allowing urine to bypass the bladder and drain directly into a child’s diaper. A ureterostomy eventually has to be reversed, and the ureter reimplanted.

Some type of intervention becomes necessary when children with POM experience recurrent urinary tract infections, kidney or ureteral stones, pain due to the obstruction, or worsening dilation with decreasing renal function.

“Open surgery involves a several-centimeter incision, pain, and staying in the hospital at least one night, and it’s challenging to do in babies under 1 year old,” said Boswell, who’s also an assistant professor of pediatric urology at University of Alabama at Birmingham (UAB). “But it has a greater than 95% success rate.”

However, Boswell authored a February 2024 study in the Journal of Pediatric Urology that suggested that HPBD is a promising alternative. Evaluating the outcomes of using HPBD in 15 infants under 1 year old with progressive or symptomatic POM and tracking participants for an average of 2.9 years, he and his colleagues found the minimally invasive approach to be successful in 80% of cases, sparing most of the babies from subsequent invasive open surgeries.

Because no incisions are involved, HPBD is potentially safer than open surgery and can be done in younger babies, Boswell notes. “As of the 2010s, only a couple of centers in the United States were doing it,” he said. “We’ve been doing it at Children’s since 2023.”

Boswell, who spoke on the topic at the American Academy of Pediatrics Section on Urology in September 2025 and continues to publish papers, hopes more institutions will consider HPBD for children with POM. He also wants to spearhead research that would directly compare the open and minimally invasive approaches for a clearer picture of the pros and cons.

“We know we can do this procedure without needing an incision, but there have never actually been good comparative studies,” Boswell said. “I hope pediatric urologists across the country and world can band together to deliver well-designed studies to see what’s best for patients.”

July 28, 2026 by