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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
Nephrology, Urology

A New Pathway for Prenatal Hydronephrosis

A model of the kidney (Stock photo)

A multidisciplinary team at Children’s of Alabama and the University of Alabama at Birmingham (UAB) has developed a standardized clinical pathway for newborns diagnosed prenatally with hydronephrosis, reducing variability in care, improving coordination among specialties, and helping families receive timely guidance without unnecessary testing or travel.

The pathway, developed by general pediatricians in the newborn nursery in collaboration with pediatric nephrology and pediatric urology, provides a risk-stratified approach to determining which infants require immediate evaluation, which can be safely monitored, and which need little to no intervention. The initiative has already prompted changes in workflow, increased access to telehealth services, and generated interest from providers outside Birmingham.

Prenatal hydronephrosis, or dilation of the kidney’s collecting system, is one of the most common abnormalities identified on prenatal ultrasound. While some cases resolve spontaneously, others may signal underlying conditions such as urinary tract obstruction, vesicoureteral reflux, urinary tract infection risk, or chronic kidney disease. Determining which infants need urgent intervention has historically been challenging.

“We found the existing guidelines confusing,” said Terry Wall, M.D., division director of the UAB Division of Academic General Pediatrics and attending physician in the newborn nursery. “Different specialties interpreted them differently, radiology reports varied in terminology, and there was a lot of inconsistency in how babies were evaluated and referred.”

Wall, who is also a medical informaticist, brought together leaders in pediatric nephrology and pediatric urology to create a single algorithm that could be used consistently by nursery physicians, specialists, radiologists, and obstetric providers.

The resulting pathway categorizes infants based on prenatal and postnatal imaging findings, including the degree of hydronephrosis, bladder abnormalities, and progression over time. Infants identified as high risk are evaluated by urology or nephrology before discharge, while lower-risk patients receive targeted education and follow-up recommendations.

David Askenazi, M.D., pediatric nephrologist and medical director of the Pediatric and Infant Center for Acute Nephrology at UAB, said the pathway was designed with two goals in mind: ensuring that babies with significant disease are identified early while avoiding unnecessary interventions for families whose infants are unlikely to require treatment.

“We don’t want to miss a child who needs to be seen right away, but we also don’t want to burden families when their baby has a mild finding that is likely to resolve,” Askenazi said.

For infants requiring specialty follow-up, the pathway introduced another innovation. Stacy Tanaka, M.D., chief of pediatric urology, established a telehealth model that allows families to meet with pediatric urologists approximately two weeks after discharge.

Previously, referrals often occurred through community pediatricians, and specialists frequently lacked access to postnatal imaging before the initial visit. Families would travel to Birmingham for an appointment, only to learn that additional studies were needed.

Now, newborn ultrasounds are obtained before discharge when indicated, and specialists can review imaging in advance of the telehealth visit. During these appointments, providers discuss results, explain whether additional testing is needed, determine if antibiotic prophylaxis is appropriate, and establish a plan for ongoing surveillance.

“It has helped our workflow tremendously,” Tanaka said. “It also allows us to set expectations for families much earlier. If they need another study, they know why. If the hydronephrosis is likely to resolve, they understand what we’re watching and what to expect.”

This approach is particularly beneficial for families traveling from rural communities or other regions of Alabama. Parents of newborns can participate in appointments from home rather than making repeated trips for visits that may not require in-person evaluation.

The pathway also has strengthened communication among departments. Discussions with radiology and obstetrics have focused on standardizing prenatal ultrasound reporting so nursery providers can more easily place patients into the appropriate risk category.

Although the initiative was implemented only recently, providers say it already has reduced confusion, improved consistency, and enhanced education for both families and primary care physicians.

The work ultimately may extend beyond Children’s. Tanaka has shared the algorithm with pediatric urologists in Mobile, Ala., and Askenazi plans to discuss the model with colleagues in the Neonatal Kidney Collaborative, an international network focused on improving kidney care for newborns. “We’ve worked out many of the details,” Wall said. “If other centers can use what we’ve learned to standardize care and improve outcomes for families, that’s a win for everyone.”

July 24, 2026 by
Pulmonology

Finding Early Warning Signs of CF-Related Kidney Disease

William “Tom” Harris, M.D., is a pulmonologist at Children’s of Alabama and UAB.

By Charles Buchanan

Cystic fibrosis (CF) is often defined as a disease of the lungs. But as advanced therapies help today’s young patients breathe easier and live longer—many will reach their 60s, according to the 2024 Cystic Fibrosis Foundation Registry—attention is shifting to the disease’s impact on other organs that may be vulnerable to the consequences of aging. This evolving landscape of CF clinical care has prompted Tom Harris, M.D., a pulmonologist at Children’s of Alabama and the University of Alabama at Birmingham (UAB), to investigate the kidneys.

“Interestingly, there’s more CFTR [cystic fibrosis transmembrane conductance regulator], the protein that causes cystic fibrosis, in the kidneys than the lungs,” Harris said. That means that as people with CF grow older, they face a higher incidence of chronic kidney disease than the general population, where the risk is about one in seven, according to Harris. Acute kidney injury (AKI), is more prevalent among people living with CF due to frequent antibiotic exposure and previous hospitalizations, and recurrent AKI is a major risk factor for development of chronic kidney disease. Harris also suspects loss of CFTR function takes away some of the kidney’s reserve.

Protecting the kidneys and other organs that express CFTR is crucial as lung disease stabilizes and people with CF age to help prevent health complications that can consume the patients’ hard-earned longevity. “The priorities of CF are changing,” Harris said. “We are now very much prioritizing quality of life across the years.”

Not every person with cystic fibrosis will develop kidney disease, of course. The challenge for researchers like Harris is to find biomarkers that will identify the ones at risk—and sound the alarm early enough for therapeutic intervention to preserve kidney function. “Right now, we are trying to establish which biomarkers are important and how they might indicate the progression of chronic kidney disease over time,” Harris said. Joining him in this mission are a team of scientists across the country who are part of a landmark project funded by the Cystic Fibrosis Foundation (CFF). Together they will follow a group of inpatients and outpatients for three years to study promising new diagnostic tools for CF-related kidney disease. They also are looking at kidney disease in the CF animal model that was pioneered at UAB. “We are very grateful to the CFF for having such vision to allow us to lay such a firm foundation to study kidney disease, combining both human observational study with mechanistic analyses in gene-edited animal models,” Harris said. “We are hopeful this project will allow us to pioneer the field of CF kidney disease and health.”

The researchers are focusing on urine in their quest to find novel biomarkers because of its direct connection to kidney health. Urine is “like a liquid biopsy,” Harris said. “With every urinary output, you can measure how well the kidney is working.” Physicians traditionally have tested urine or blood for elevated levels of specific proteins, electrolytes, and waste products such as creatinine to find proof of disease. But organ damage has already occurred by the time those reveal a problem, Harris said. Instead, he and his colleagues are investigating more subtle, sensitive measures that could flash the earliest warning signs of trouble. Candidates include kidney injury molecule (KIM-1) and neutrophil gelatinase-associated lipocalin (NGAL), two urinary biomarkers indicating minute structural changes in the kidney that precede a deterioration in function.

“In addition to detecting which patients might have some evidence of disease, we also want to use those biomarkers to help us understand the pathways of disease,” Harris said. “Is it more fibrotic? Is it more inflammatory?” Exosomes, which are the molecular packages transmitted between cells, offer a prime example. Exosomes can be informative about the intercellular communication in health and disease, but they also often carry the mediators that affect change. For instance, neutrophil-derived exosomes may shed light on the inflammatory triggers of kidney disease.

Such detailed methods of diagnosis could hold promise for designing personalized treatments for patients. CF already is a precision medicine success story following breakthrough discoveries about the CFTR gene that causes the disease, including the distinct ways in which each CFTR mutation affects protein function. Some mutations impact how much CFTR is made; some affect how well CFTR gets to the cell surface; some impact how well CFTR transports electrolytes. Knowing each patient’s genetic mutation plays a role in the choice of CFTR-directed therapy.

Now, researchers are applying what they know about CFTR’s impact in the lungs to the kidneys, where they suspect it plays a different role. In the lungs, CFTR is needed to transport chloride ions, and a lack of it can cause airway secretions to thicken. But in the kidneys, CFTR is involved in acid-base metabolism, which may be disrupted in chronic kidney disease. “Part of the reason CF-related kidney disease has been overlooked previously is that, instead of being a disease of obstructed lumens from mucus plugging, the kidney disease is an organ of pH balance and fluid transport,” Harris said. Scientists want to pinpoint the specific cell types and regions of the kidney that are affected most by CFTR dysfunction. “CFTR expression is not the same across all cell types in either the lung or the kidney. In the lung, an ionocyte that is positioned near mucus glands is the highest CFTR-producing cell,” Harris said. “Investigators at UAB have recently discovered a similarly high CFTR-expressing cell in the kidney. Future steps will be to define how this high CFTR-expressing cell promotes renal health.” These findings could illuminate new targets for potential treatments to protect kidney function and help patients thrive as they age.

“The future’s bright,” Harris said. “CF has primarily been considered a pediatric disease. Now it’s very much an adult disease. And we as pediatricians have to think about the future . . . to transition our focus from disease to health—and to celebrate the wonderful, previously unimaginable question of how can we help our pediatric patients with CF age well into senior adulthood.”

For more information about Harris’ research, check out this episode of the Children’s of Alabama PedsCast.

July 24, 2026 by
Cardiology

Aortic Arch Surgery and Cognitive Development

A Children’s cardiac surgeon is researching the connecting between aortic arch surgery and brain development. (Stock image)

By Charles Buchanan

Parents naturally ask plenty of questions when their newborn needs aortic arch reconstruction, a life-saving surgery for congenital malformations restricting blood flow. Their major concerns involve the procedure’s complex logistics and potential complications, which Hampton Gray, M.D., a Children’s of Alabama cardiac surgeon, can explain in detail. But not every answer comes so easily. He says some of the simplest questions from parents are also the toughest: “How’s my kid going to be when he is 5 years old? Can he go to school, or is he going to be delayed? Is he going to be behind the other kids?”

Their worries arise from a critical component of aortic arch reconstruction—the temporary reduction or shutdown of blood circulation throughout the body and to the brain. And the reason those questions are difficult to answer is that little is known about the surgery’s long-term effects on brain development. “There is limited data currently for us to properly educate parents on how their kid will cognitively develop through infancy, toddler, and school-age years,” Gray said. Now he is spearheading a novel, multiyear research project to fill that knowledge gap. The findings could provide parents with the answers they need and help them understand what to expect as their children grow.

Cardiac Surgery Meets Psychology

The trial kicked off in July, funded by an $80,000 grant from the Kaul Pediatric Research Institute, a Children’s/University of Alabama at Birmingham (UAB) program supporting trailblazing work from rising investigators. During the next two years, Gray and his team will follow up with Children’s patients who had major open-heart surgery to repair a congenitally small native aorta in the last 15 years. That cohort includes up to 200 children, though Gray anticipates the study will attract approximately 80 participants ranging in age from infants to school-age children.

To measure the patients’ long-term progress, Gray has forged an innovative collaboration with the clinical psychologists at UAB and Children’s. “They are pros at testing kids about cognitive function, executive function, fine motor skills, and all the things that dictate how your brain is developing as a young child,” Gray explained. UAB already has an established Newborn Clinic, where the clinical psychologists gauge the growth and development of children who spent time in the neonatal intensive care unit (NICU). For the cardiac surgery study, they created a novel algorithm to tailor their tests for the varying age levels of patients following aortic arch surgery. They also will administer the tests to participants and interview parents about their child’s cognitive development.

“It will be very valuable to test these kids at different time points and different age groups,” Gray said. With the cognitive development data in hand, the researchers will evaluate the trajectories of aortic arch patients alongside children who have not experienced heart surgery.

A Tale of Two Strategies

The study also may shed new light on the two cerebral perfusion strategies used to manage blood circulation during aortic arch surgery. The researchers are eager to know if the techniques affect brain development differently, which leads to the inevitable question: Is one option better than the other?

The original cerebral perfusion strategy, deep hypothermic circulatory arrest (DHCA), involves cooling the body to a temperature between 18 and 20 degrees Celsius and turning off the heart-lung machine so that no blood circulates through the body. That gives cardiac surgeons approximately 40 minutes to complete the reconstruction without increasing the risk for brain injury, Gray said. Cardiac surgeons following the newer strategy, antegrade cerebral perfusion (ACP), cool the body to the same low temperatures but also sew a small graft to the innominate artery and keep the heart-lung machine running, selectively perfusing the brain. As a result, about 15 to 20% of the entire cardiac output continues flowing, according to Gray’s estimate. Today, at least 70 to 80% of cardiac surgery centers, including Children’s, have adopted ACP while the rest continue to rely on DHCA, he noted.

“It would make sense, theoretically, that giving the brain a little bit of blood flow would be better than giving it no blood flow,” Gray said. However, in a 2024 study comparing the two cerebral perfusion strategies, he and his research team found no significant differences in short-term hospital outcomes among 165 newborns and infants undergoing aortic arch surgery at Children’s between 2012 and 2023. Both types of patients also experienced a low rate of neurologic events such as stroke and seizure.

Gray’s current project, with its long-term, cognitive development focus, offers a logical next step in identifying any differences that emerge between DHCA and ACP patients as they grow up. The study’s participants will include the two groups, since both cerebral perfusion strategies were in use at Children’s as recently as 2022, giving the researchers ample opportunities to compare outcomes. The team also will gather information about nonsurgical factors that can influence brain development, including the children’s family structures and education, to round out the picture of each child’s growth.

Answers at Last

Gray hopes the research will serve as a stepping stone to a broader exploration of aortic arch patients and their progress. Ultimately, he would like for the findings to serve as pilot data for a larger initiative involving multiple cardiac surgery centers and extramural funding from sources such as the National Institutes of Health. The most useful information would come from a trial that pairs a DHCA-exclusive center with an ACP-exclusive center and follows patients from both over several years, he said.

No matter where his investigation leads, Gray says the goal remains the same: to provide parents with meaningful answers to their simple, yet tough, questions about their child’s future. And if the cardiac surgeons and clinical psychologists make pioneering discoveries about the impact of aortic arch surgery along the way, that’s a bonus. “Children’s supports pushing the envelope to make children’s lives and parents’ lives better,” Gray said.

July 24, 2026 by
Neurology & Neurosurgery

Time is brain: A pediatric code stroke program

Code Stroke at UAB and Children’s of Alabama is designed to improve recognition, response and outcomes. (Stock photo)

By Heather Watts

A stroke is often thought of as a condition of adulthood, yet it remains a significant and underrecognized cause of morbidity and mortality in the pediatric population. Despite being cited among the leading causes of death in children, pediatric stroke is frequently missed or diagnosed late, in part due to its relative rarity, diverse clinical presentations and the unique risk factors that distinguish it from adult stroke. As a result, many children with stroke present outside the narrow window during which acute interventions may be considered, limiting opportunities for therapies that can meaningfully alter neurologic outcomes. In pediatric stroke, as in adult stroke, the principle remains the same: Time is brain.

Improving pediatric stroke education

During her training in child neurology at the University of Alabama at Birmingham (UAB), Sarah Novara, M.D., MSQHS, FCNS, associate professor in the Division of Pediatric Neurology, had several patient encounters that highlighted both the devastating potential of delayed stroke recognition in children and the extraordinary opportunity that exists when stroke is identified and treated promptly.

“When we were able to quickly evaluate and treat stroke symptoms in our pediatric patients, we saw amazing neurologic recovery,” Novara explained. “Seeing the importance of early stroke recognition firsthand inspired me to improve our pediatric stroke education and standardization processes at Children’s of Alabama and UAB.”

As a senior resident, Novara developed pediatric stroke education and streamlined order sets and processes for residents, fellows and faculty. Novara worked with Tony McGrath, M.D., associate professor in the Division of Pediatric Neurology and Nancy Tofil, M.D., M.Ed., professor in the Division of Pediatric Critical Care, to develop a pediatric stroke simulation as part of pediatric stroke education for trainees and faculty. “The simulation has been highly efficacious in advancing pediatric stroke evaluation and management knowledge in a variety of learner settings since its creation,” Novara explained.

From education to systems change: Creating a Pediatric Code Stroke

Once on faculty at UAB, Novara continued her work with pediatric stroke education and began working on improving early stroke recognition among providers at Children’s and UAB by establishing a Code Stroke for pediatrics.

“We decided to model a Code Stroke process after our adult neurology colleagues and other select children’s hospitals across the U.S.,” Novara said. The pediatric Code Stroke initiative aims to offer necessary, efficient evaluation and management of patients presenting with signs of possible stroke, and if inevitably they have not had a stroke, the Code Stroke process assists in evaluating and managing conditions that mimic stroke and deserve appropriate treatment. 

In the summer of 2024, the Code Stroke working group met to create the Children’s of Alabama Code Stroke protocol for patients greater than one month of age with acute neurologic deficits and who were last known at their neurologic baseline less than 24 hours prior to presentation at the hospital. This is the window in which options of acute stroke intervention may be offered, if there are no contraindications. In addition to the protocol, order sets within EPIC were streamlined for the evaluation of Code Stroke patients in the emergency department (ED) or on the hospital floors, and stroke patient admission order sets were provided as well.

This Code Stroke effort was spearheaded by Novara, Tofil and Jeffrey Blount, M.D., MPH, professor in the Division of Pediatric Neurosurgery. It also included colleagues from pediatric emergency medicine, neuro-interventionalists, radiology, nursing, and operators.

After the Code Stroke protocol was established and education was provided across the pediatric divisions, the Children’s of Alabama Code Stroke went live in September 2024. As of July 2026, a Code Stroke had been called 131 times (either in the ED or on a hospital floor). Approximately 12% of these Code Strokes have identified ischemic or hemorrhagic strokes, allowing for efficient evaluation and management. Several of the pediatric acute ischemic stroke patients have even benefited from an acute thrombectomy performed by the on-call neuro-interventionalists. Code Stroke patients with hemorrhagic stroke have benefited from the expedited care of the pediatric neurosurgery team. Many of the Code Stroke patients have made remarkable recoveries.

“We have been very excited about the success of multidisciplinary care within the Code Stroke process, as many patients—even those without strokes—have received expedited treatment for life-altering conditions,” Novara said.

“The Code Stroke working group meets quarterly to continuously discuss ways in which to improve our Code Stroke protocol and to collaborate together as we try to provide the best care for our patients,” Tofil added.

Expanding care beyond the acute phase: Pediatric Stroke Clinic

In early 2025, a monthly Stroke Clinic was established by Novara and McGrath to provide a unique pediatric stroke follow-up clinic that offers ongoing patient support, education and follow-up care, including best efforts at secondary stroke prevention. 

In the monthly stroke clinic, the pediatric neurology team collaborates with pediatric hematology and neurosurgery colleagues in the care of unique pediatric patient populations seen in their clinics who are at risk for stroke. The stroke clinic also allows the pediatric neurology team to provide effective transition of care for patients from pediatric to adult stroke care at UAB as needed.  

The pediatric stroke clinic at Children’s of Alabama is a participating site within the International Pediatric Stroke Study, which is a research group working hard within the International Pediatric Stroke Organization to expand the knowledge about pediatric stroke and best practices for these unique patients.

The Code Stroke program has demonstrated that targeted educational initiatives, combined with the development of standardized, multidisciplinary response protocols, can meaningfully improve the evaluation and management of children presenting with possible pediatric strokes.

As awareness grows and standardized care pathways expand, there is an opportunity to reduce the burden of pediatric stroke and ensure that children receive timely, evidence-informed care when minutes matter most.

July 22, 2026 by
Neurology & Neurosurgery

Lalor appointed Director of Pediatric Neurology

Kathryn Lalor, M.D. was appointed director of the Division of Pediatric Neurology in May 2026.

By Angel Pine

As the new director of the Division of Pediatric Neurology, Kathryn Lalor, M.D., aims to build on the strong foundation already established within the division.

Lalor, who was appointed to the position in May, has been a valued member of the division as associate professor, contributing to its continued growth in both clinical care and academic excellence. In her new role, she will lead efforts to further strengthen the division’s mission across patient care, education, and research.

“Dr. Lalor joined the division in the midst of its recent growth,” said Leon Dure, M.D., professor and former division director of Pediatric Neurology. “She has the skills and temperament needed to ensure UAB Pediatric Neurology’s reputation of academic and clinical excellence.”

“This appointment represents an opportunity to grow into a new kind of leadership which I plan to approach with humility and intentionality,” Lalor said. “Leon Dure has left big shoes to fill, but I am thankful to continue growing the supportive culture he has fostered.”

Lalor also expressed enthusiasm about the division’s future, noting its significant growth over the past decade and the opportunity to build on that momentum. Lalor emphasized the importance of collaboration across the division, adding, “If you want to go fast, go alone. If you want to go far, go together,” as she looks forward to working alongside faculty, staff and trainees to continue advancing care for children across Alabama.

Her appointment reflects the department’s continued commitment to strong leadership and advancing pediatric neurological care.

July 22, 2026 by
Neonatology

Studying magnesium sulfate in very preterm babies

Research shows magnesium sulfate does not improve neurodevelopmental outcomes in very preterm babies. (Stock photo)

By Anna Jones

Research led by Children’s of Alabama and the University of Alabama at Birmingham (UAB) shows that magnesium sulfate does not improve neurodevelopmental outcomes in babies born very preterm between 22 and 24 weeks gestation.

Babies born during 22-24 weeks of gestation have a higher risk of neurodevelopmental impairment. While prior studies have found that magnesium sulfate helps prevent the development of cerebral palsy for babies born at later gestational ages between 24 and 32 weeks, this observational study led by Margaret Page, M.D., and Ashley Battarbee, M.D., in the UAB Department of Obstetrics and Gynecology, along with colleagues in the Department of Pediatrics, is one of the few studies of its kind to look at the use of magnesium sulfate for babies born at 22-24 weeks of gestation.

“This multicenter study led by Dr. Page and colleagues at UAB is important as it is the largest study designed to assess the two-year outcomes of infants born extremely preterm exposed to antenatal magnesium sulfate and/or steroids, two common treatments given before delivery,” said Wally Carlo, M.D., co-director of Neonatology at UAB and Children’s of Alabama and the Neonatal Research Network.

Battarbee says that OBGYNs cannot always stop a preterm birth, so they oftentimes need to shift their focus to how they can best prepare the baby to be born early.

“We consider interventions such as administering magnesium sulfate or antenatal corticosteroids to the pregnant patient to help improve outcomes for their baby after birth,” Battarbee said. “While the American College of Obstetricians and Gynecologists (ACOG) recently updated their guidance on corticosteroids for babies at 22 weeks, we did not have updated guidance on magnesium sulfate and wanted to explore this treatment further.”

The results of the recent study reinforce current national guidelines recommended by ACOG and the Society of Maternal-Fetal Medicine that do not recommend giving magnesium sulfate at 22 weeks and instead prioritizing antenatal corticosteroids to improve neurodevelopmental outcomes. Unlike magnesium, steroids have demonstrated benefit for infants born at very early gestational ages and remain the primary intervention when an early delivery is anticipated.

“There is not a lot of guidance on the use of magnesium sulfate in babies at this gestational age,” said Page, the lead investigator of the study. “Through this research, we were able to find that there was no benefit to using magnesium sulfate in addition to antenatal corticosteroids. This shows us that more treatment does not always equal better outcomes.”

Both Page and Battarbee emphasize that administering magnesium sulfate at that gestational age did not lead to any measurable increase in maternal or fetal harm in this study, but magnesium does carry known maternal risks, making it important not to use it without proven benefit. Additionally, using magnesium for neuroprotection in babies at these very early gestational ages when it is not effective may hinder future research in identifying interventions that truly make a difference.

This analysis was conducted using data from and in collaboration with the Neonatal Research Network, a large research network encompassing academic institutions across the United States funded by the Eunice Kennedy Shriver National Institute of Child Health and Human Development.

July 22, 2026 by
Endocrinology

Ashraf co-edits textbook on pediatric diabetes

Ambika Ashraf, M.D. is the director of the Division of Pediatric Endocrinology and Diabetes at Children’s of Alabama and UAB.

By Amy Richardson

A new textbook, co-edited by Children’s of Alabama pediatric endocrinologist Ambika Ashraf, M.D., offers a comprehensive look at pediatric diabetes, highlighting the latest research findings and clinical guidance for managing diabetes in children and adolescents.

Written by international experts from leading diabetes care centers, “Pediatric Diabetes” covers major forms of the disease, including Type 1 diabetes (T1D), Type 2 diabetes (T2D), Wolfram syndrome and cystic fibrosis-related diabetes. It also provides up-to-date management strategies for evolving diabetes phenotypes and current clinical approaches to care.

Ashraf, who also serves as director of the UAB Division of Pediatric Endocrinology and Diabetes, says the book addresses a critical gap in clinical resources focused specifically on pediatric diabetes. “Most available information on pediatric and adolescent diabetes has historically been limited to chapters within larger pediatric endocrinology books, without the space to cover specific topics in depth,” she said. “That’s what makes this book valuable. It fills a genuine gap in the literature.”

Ashraf co-edited the 15-chapter volume with Benjamin Udoka Nwosu, M.D., professor of Pediatrics and Endocrinology at the Zucker School of Medicine at Hofstra/Northwell in New York. She also co-authored two of the book’s chapters: “Precision Medicine in Diabetes Phenotypes” and “Neonatal Diabetes.” Mary Margaret Barr, M.D., a fellow in the Joseph S. Bruno Pediatric Endocrinology Training Program at UAB, co-authored Neonatal Diabetes with Ashraf. Barr will be joining the Division of Pediatric Endocrinology and Diabetes as a faculty member in July 2026.

Pediatric diabetes one of the most common chronic diseases among individuals under age 20 in the United States. In 2022, an estimated 21,732 youth under 18 were newly diagnosed with T1D, and 14,490 were diagnosed with T2D. Between 2001 and 2017, the prevalence of T1D in U.S. youth increased by 45%, with the largest increases among non-Hispanic white and non-Hispanic Black youth. Over the same period, T2D prevalence increased by 95%, with the largest increases among non-Hispanic Black and Hispanic youth. Based on increasing rates, by 2060, the number of youth with T1D is projected to reach 335,000, and the number of youth with T2D is expected to reach 220,000—increases of 65% and 673%, respectively.

“Pediatrics Diabetes” is published by Springer as part of the Contemporary Endocrinology series and is available in print (ISBN: 978-3-032-17035-4) and eBook (ISBN: 978-3-032-17036-1) formats at Springer.com and Amazon.

Ashraf also holds the Ralph Frohsin Endowed Chair in Pediatric Endocrinology at UAB and serves as associate director of the UAB Comprehensive Diabetes Center. Ashraf is also co-editor of “Pediatric Dyslipidemia,” published by Springer in 2023.

July 21, 2026 by