Inside Pediatrics

Managing Short Bowel Syndrome & Intestinal Failure

Sirine Belaid, M.D., created a new curriculum to teach residents how to manage the complexities of SBS and IF in pediatric patients.

When Sirine Belaid, M.D. was a fellow at University of Pittsburgh Medical Center, she noticed a problem with the management of patients with short bowel syndrome (SBS) and intestinal failure (IF)—residents had little confidence in caring for patients with these conditions. This was understandable—these patients have highly complex needs, and residents, being new in the profession, are still learning. Plus, they didn’t have the proper training. “I didn’t blame them because at that point in time there was no curriculum in place basically to help in the care of these patients,” said Belaid, who’s now an attending gastroenterologist at Children’s of Alabama and an assistant professor at the University of Alabama at Birmingham (UAB). She decided to address the problem by creating a curriculum herself.

“I wanted them to ease their insecurities and their fear and make them confident and comfortable in taking care of these kids,” she said.

Belaid created and implemented the curriculum during her fellowship in Pittsburgh before joining Children’s and UAB in August 2025. Since arriving, she has begun to implement the program for fellows in Birmingham and aims to do the same for residents. Her study on its effectiveness was published in early 2026.

When she started the project, Belaid aimed to create a curriculum that addressed complexities associated with SBS and IF. Patients with these conditions, she said, present with three key challenges: unique anatomy, required devices, and potential complications.

IF is often caused by SBS, which can occur in children in two ways—either they’re born with it or they develop it following surgical complications. The condition leaves them with a shortened small intestine or other anatomical changes that affect their ability to absorb nutrients. As a result, they’re dependent on parenteral nutrition through a central line that provides lipids, carbohydrates, and all the other nutrients they need to grow and, in some cases, survive. Patients often have gastrostomy tubes, jejunostomy tubes or stomas. These enteral tubes, central lines and the patients’ anatomical differences can predispose them to complications, such as ostomy prolapse or necrosis, gastrojejunostomy tube dislodgement, line dislodgment, or line infection.

For untrained residents and other providers, these complexities can be daunting. In some cases, their lack of understanding can lead to misdiagnosis. “I’ve had so many kids who see primary care providers with fever, and they have their central line, and [the providers] just say, ‘Well, it could just be a virus. Just go home,’” Belaid said. But if the child is actually suffering from a central line infection, that’s a mistake that could prove fatal, she added.

Historically, patients with IF rarely survived into adulthood, and many did not survive childhood. But thanks to the emergence of better treatment options in recent years, more patients with SBS and IF are surviving and thriving. “We are seeing more and more of these kids—they are becoming a growing population,” Belaid said. “And so we need to have our residents ready to manage the kids, especially when they come in the [emergency department].”

For Belaid, this underscored the urgency for developing a curriculum. And the job was the perfect marriage of her two passions: intestinal rehabilitation and education. So when she discovered the problem during her fellowship, she began doing research to see how she could address it.

Belaid started by asking the residents to fill out a needs assessment survey to determine in which areas they needed the most help. It revealed their confidence level in certain tasks along with their preferred education materials. Using this data, Belaid created a five-month curriculum divided into three parts:

In-person lecture – This lasted 45-50 minutes and summarized the most common topics related to intestinal rehabilitation while allowing for interactive discussions.
Total parenteral nutrition (TPN) workshops – Each week, Belaid presented two cases designed to help residents understand various parts of the TPN process, with the residents performing these tasks more independently as they progressed through the curriculum.
Quick-reference survival guide – Belaid created a guide residents could keep in their pockets or save digitally that summarizes key points and how to handle emergencies.

After residents completed the curriculum, Belaid asked them to fill out another survey to determine their progress. It showed that the curriculum significantly improved resident confidence across nearly every assessed skill, and it increased appreciation for the educational value of caring for patients with SBS and IF. Residents also gave excellent feedback on the curriculum.

Now, Belaid is working to replicate the process at Children’s and UAB. In the meantime, she’s sharing her successful strategies with other gastroenterologists across the country. She has presented her research at the North American Society for Pediatric Gastroenterology, Hepatology & Nutrition (NASPGHAN) Annual Meeting, the American Society for Parenteral and Enteral Nutrition (ASPEN) conference, and other events. “I’m really hoping to disseminate this curriculum nationally,” she said. “That’s my goal.” She believes her approach can be effective for other specialties, as well.

In the process, she hopes her work will encourage more residents to pursue a career in intestinal rehabilitation, just as she was inspired to do during her own residency when she was first exposed to the complex needs of patients with IF. She says she discovered the profound satisfaction of helping children wean off parenteral nutrition and eventually have their central lines removed, allowing them to swim, run, and enjoy the everyday experiences of childhood. “Everything began during my residency at the University of Iowa Health Care, where my mentor, Dr. Riad Rahhal, first sparked my interest in intestinal rehabilitation. His guidance and mentorship shaped my passion for the field and ultimately influenced my career path, for which I am deeply grateful,” she said. “I just fell in love with it and with the patients and their parents. And seeing the joy on their face when their kid is finally without a line, without anything—it’s pure joy.”

August 6, 2026 by childrensal

Hematology and Oncology

Using integrative rehabilitation for cancer care

Kelli Chaviano, D.O., is helping pediatric cancer survivors through the Integrative Cancer Rehabilitation program.

By Heather Watts

Cancer treatment, while lifesaving, often comes with a wide range of physical, emotional and social challenges for young patients. Pediatric cancer survivors may face long-term effects from their treatments, impacting everything from mobility and strength to cognitive function and emotional well-being. To address these challenges, Kelli Chaviano, D.O., assistant professor in the Division of Pediatric Rehabilitation Medicine, developed the Integrative Cancer Rehabilitation service line (I CAN Rehab) to provide comprehensive rehabilitation support throughout the cancer care continuum.

“The need for specialized pediatric cancer rehabilitation was a driving force behind the creation of the I CAN Rehab service line,” Chaviano explained. “The initiative ensures that children do not only survive cancer treatment but also thrive afterward, with the ability to regain and improve physical, cognitive, and emotional abilities.”

The program facilitates improved collaboration between the rehabilitative care and oncology teams, allowing for more individualized and holistic treatment plans. “By addressing the specific needs of pediatric cancer patients, I CAN Rehab ensures that treatment is not just about survival but also about improving the functional capabilities and quality of life of these young patients,” Chaviano said.

It provides a multifaceted approach, including rehabilitative therapies, orthotics/prosthetics, and therapy care, all aimed at enhancing both physical and psychological recovery. The service is structured to offer care at different levels, from acute consultations to outpatient follow-ups, ensuring that patients have continuous access to vital rehabilitation support.

Institutions such as the Commission on Cancer, the National Comprehensive Cancer Network, the American Cancer Society, the American Society of Clinical Oncology, and the National Academy of Medicine have recognized the importance of rehabilitation throughout the cancer care continuum—before, during, and after treatment.

The creation and growth of I CAN Rehab was made possible through the dedication and support of department and division leadership recognizing the importance of cancer rehabilitation and aligning it with the organization’s mission of providing comprehensive and compassionate care. Additionally, the collective efforts of pediatric rehabilitation medicine, oncology, and therapy colleagues have been central in reinforcing the collaborative nature of the service line.

The supportive environment at the University of Alabama at Birmingham (UAB) Department of Pediatrics and Children’s of Alabama has allowed the program to grow through key developments such as educational initiatives, the creation of treatment protocols, and increased research in cancer rehabilitation.

A notable program expansion is the I CAN LEAP initiative (Integrative Cancer Rehabilitation: Launching Early Acute-rehab Pathway). This two-week, individually tailored program is designed for children with cancer who need intensive rehabilitation early in their treatment process. By providing acute therapy, I CAN LEAP ensures functional improvements through personalized therapy intensity and promotes active collaboration among pediatric rehabilitation medicine specialists, oncologists, and therapy teams.

The I CAN Rehab service line represents a crucial advancement in pediatric cancer care, ensuring that children not only survive but thrive throughout and after their cancer treatments. By integrating rehabilitation into the cancer care continuum and fostering collaboration among multidisciplinary teams, I CAN Rehab helps children regain physical, emotional, and social well-being. As the service line continues to evolve, it holds great potential to improve the lives of countless young patients while pushing the boundaries of cancer rehabilitation research and practice.

Through its expansion, the program is not only transforming the care model at Children’s of Alabama but is also gaining recognition at a national and international level for its innovative approach to pediatric cancer care.

August 6, 2026 by childrensal

Neurology & Neurosurgery

Children’s and UAB expanding access to promising DMD therapy

A researcher working in a lab at UAB (File photo)

By Angel Pine

Children’s of Alabama and the University of Alabama at Birmingham (UAB) Department of Pediatrics are expanding access to a promising investigational therapy for patients with Duchenne muscular dystrophy (DMD), offering new hope for families affected by the progressive neuromuscular disease.

Through an expanded access program, they will begin offering delpacibart zotadirsen, a novel antibody-oligonucleotide conjugate (AOC) developed by Avidity Biosciences. The program gives select patients access to the therapy before full U.S. Food and Drug Administration approval while researchers continue evaluating long-term outcomes.

Samantha Weaver, DNP, CRNP, assistant professor in the UAB Division of Pediatric Neurology, says the therapy represents an important step forward in the treatment of DMD.

“There is still no cure for Duchenne muscular dystrophy, therefore we are always interested in expanding access to therapies that may improve quality of life and slow disease progression,” she said.

Duchenne muscular dystrophy is an inherited neuromuscular disorder caused by changes in the DMD gene, one of the largest genes in the human body. The condition primarily affects boys because it is inherited in an X-linked pattern. Sequence changes in the DMD gene prevent the body from producing dystrophin, a critical protein that helps protect muscle cells during movement and contraction. Without dystrophin, muscles become increasingly damaged over time. “In the absence of dystrophin, fragile muscle fibers become susceptible to contractile injury, leading to damage and progressive weakness,” Weaver explained.

Early signs of DMD can include delays in walking, enlarged calf muscles, and weakness in the hips and thighs. Symptoms typically worsen throughout childhood, with many patients losing the ability to walk between ages 8 and 12 years of age. In later stages, the disease can affect the heart and lungs, leading to serious complications such as heart and respiratory failure.

UAB and Children’s currently care for approximately 80 patients with Duchenne muscular dystrophy through the multidisciplinary Muscular Dystrophy Association (MDA) clinic, the only nationally designated MDA care center in the state.

Over the past two decades, advances in genetic research have significantly improved treatment options for DMD. While early therapies focused primarily on reducing inflammation through long-term steroid use, newer approaches aim to address the root cause of the disease via dystrophin restoration.

Steroids remain a standard treatment to help slow the inflammatory damage that occurs alongside muscle breakdown. Combined with multidisciplinary care, these therapies have improved life expectancy for many patients. “Thanks to routine corticosteroid treatment and coordinated multidisciplinary care, life expectancy for individuals with Duchenne muscular dystrophy has improved dramatically, with many patients now surviving into adulthood,” Weaver noted.

Delpacibart zotadirsen is an antibody-oligonucleotide conjugate, or AOC. An AOC uses a laboratory-made genetic molecule or PMO to bind to dystrophin RNA. The PMO helps the cell bypass the faulty sections of genetic instructions. A new “genetic blueprint” is formed, one that provides instructions for restored dystrophin production. Rather than permanently changing DNA, AOC therapy works by modifying RNA instructions after they are copied from the gene but before they are used to build proteins. “Although full dystrophin restoration may not be possible, enough functional protein may create a milder disease phenotype,” Weaver explained. “Even partial dystrophin restoration can lead to meaningful improvements in disease severity and progression.”

Earlier generations of exon-skipping therapies have provided modest results. Passive uptake of molecules into muscle cells produced small increases in dystrophin on muscle biopsy and limited improvements in motor function. While those therapies received accelerated FDA approval, researchers continued working to improve the selectivity of these treatments.

Delpacibart uses an antibody-mediated delivery system designed to improve uptake into muscle cells. By selectively binding to muscle cells, researchers can better tailor dosing and reduce the risk of toxicity.

According to Weaver, this next-generation approach may significantly improve dystrophin production compared to previous therapies.

In randomized, placebo-controlled trials, data supported a mean increase of approximately 25% of normal dystrophin production from baseline after four months of treatment, with some patients reaching as high as 54% restoration. Researchers also observed more than an 80% reduction in creatine kinase, a muscle enzyme that is typically elevated in patients with DMD due to ongoing muscle damage.

“We do not currently have therapies that produce this degree of creatine kinase improvement,” Weaver said. “Although these findings are encouraging in small research numbers, how these will translate to actual strength and slowing of disease is still being studied.”

The therapy is delivered once every six weeks because it does not permanently alter DNA and must be re-dosed to maintain its effect.

Only a small percentage of patients with Duchenne muscular dystrophy are eligible for exon 44 skipping therapy. Weaver estimates about 6-7% of patients have gene variants that make them candidates for this treatment. While that percentage is relatively small, Weaver emphasizes the broader significance of the program. “Six percent may not sound like a lot, but it is still meaningful for the patients who qualify,” she said. “More importantly, if this approach continues to succeed, the hope is that the same technology can be adapted to target other variants and help many more patients in the future.”

The expanded access program has received institutional approval and is supported through all required regulatory channels. UAB is now preparing to enroll eligible patients.

For families affected by Duchenne muscular dystrophy, each scientific advancement represents another step toward better treatment options and improved outcomes. “This is a really exciting development in Duchenne care,” Weaver said. “Every breakthrough moves us closer to changing the long-term trajectory of this disease.”

August 6, 2026 by childrensal

Inside Pediatrics, Uncategorized

Inside Pediatrics Offers the Latest on Kids’ Care

The Inside Pediatrics Podcast features Children’s experts with advice for parents and insight about medical advances.

Inside Pediatrics is a podcast series featuring specialists at Children’s of Alabama and the University of Alabama at Birmingham (UAB). Episodes cover topics related to pediatric health and wellness, along with research, treatment and more. In these episodes, experts provide advice for parents, as well as insight about work they’re doing to improve patient care.

FEATURED EPISODES

Pediatric Headaches, Types and Treatment

For children and adolescents, headaches can be one of the most common and most debilitating conditions. As many as 75% report having headaches at some point, and for some, it affects their lives in significant ways. In this episode, Scott Turner, DNP, describes the most common types of headaches, the challenges they create and how the Children’s of Alabama Headache Clinic is working to help patients who have them.

Autism Spectrum Disorder: Early Warning Signs, Impact and Treatment

Chances are, you’re probably familiar with Autism Spectrum Disorder, or ASD. But what are some of the early warning signs? And what should you do if you see them in your child? In this episode, licensed psychologists Dr. Allison Battaglia and Dr. Laura Stoppelbein answer those questions and more while taking an in-depth look at ASD, its impact and its treatment.

To find all episodes of the Inside Pediatrics podcast, click here. You can also check out our peer-to-peer podcast, the Children’s of Alabama PedsCast.

August 5, 2026 by childrensal

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 childrensal

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 childrensal

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

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 childrensal

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.

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 childrensal

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.

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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 childrensal

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.

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.

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 childrensal

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