Boston Children's Hospital

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Coordinates: 42°20′14″N 71°06′22″W / 42.33727°N 71.10600°W / 42.33727; -71.10600

Boston Children's Hospital
Boston Children's Hospital logo.svg
Tch-boston.jpg
Longwood Avenue main entrance
Geography
Location300 Longwood Avenue, Boston, Massachusetts 02115, U.S.A.
Organisation
Care systemPrivate
TypeTeaching
Affiliated universityHarvard Medical School
Services
Emergency departmentLevel I Regional Pediatric Trauma Center
Beds404 licensed beds
SpecialityPediatrics and pediatric subspecialties
History
Opened1869
Links
Websitechildrenshospital.org
ListsHospitals in U.S.A.

Boston Children's Hospital formerly known as Children's Hospital Boston until 2012[1] is a nationally ranked, freestanding acute care children's hospital located in Boston, Massachusetts,[2] adjacent both to its teaching affiliate, Harvard Medical School, and to Dana-Farber Cancer Institute. Dana-Farber and Children's jointly operate the Dana-Farber/Boston Children's Cancer and Blood Disorders Center to deliver comprehensive care for all types of childhood cancers. The hospital is home to the largest hospital based pediatric research program in the world. The hospital features 404 pediatric beds and provides comprehensive pediatric specialties and subspecialties to infants, children, teens, and young adults aged 0–21[3][4][5] throughout Massachusetts, the United States, and the world. The hospital also sometimes treats adults that require pediatric care.[6] The hospital uses the Brigham and Women's Hospital's rooftop helipad[7] and is an ACS verified level I pediatric trauma center, 1 of 3 in Boston.[8] The hospital features a regional pediatric intensive-care unit and an American Academy of Pediatrics verified level IV neonatal intensive care unit. Children's Hospital Boston has been ranked as best pediatric medical center by U.S. News & World Report more times than any other hospital.

The hospital is ranked as the best children's hospital in the United States.[9][10]

Overview[edit]

One of the largest pediatric medical centers in the United States,[11] Children's offers a complete range of health care services for children from birth through 21 years of age.[12] Its Advanced Fetal Care Center can begin interventions at 15 weeks gestation,[13] and, in some situations (e.g., congenital heart disease and strabismus), Children's also treats adult patients.[6] The institution is home to 40 clinical departments and 258 specialized clinical programs.[14]

From October 1, 2017, through September 30, 2018 (Children's Fiscal Year 2018), the hospital recorded:[15]

  • 622,000 outpatient visits
  • 60,000 emergency department visits
  • 28,000 inpatient and day surgical cases
  • 5.4-day average length of stay
  • a 2.13 average case-mix

The hospital's clinical staff includes approximately 2,000 active medical and dental staff, 475 residents, fellows and interns, and over 2,700 nurses. In addition to clinical personnel, Boston Children's has the largest pediatric research enterprise with 3,000 researchers and scientific staff and more NIH funding than any other children's hospital. A trained team of more than 460 volunteers devote thousands of hours each year to support the hospital staff and patients. Sandra Fenwick serves as the hospital's current CEO.

The International Center at Boston Children's Hospital serves over 2,500 patients from more than 140 countries. Services provided including coordination of visits, medical records, travel, accommodation, and immigration. The hospital offers a global medical second opinion program in partnership with Grand Rounds.[16]

In 2019, Boston Children's Hospital was ranked the top pediatric hospital by U.S. News & World Report for the sixth year in a row.[17] Boston Children's was the first stand-alone pediatric hospital in New England to be awarded Magnet status by the American Nurses Credentialing Center.[18]

History[edit]

Children's was founded on July 20, 1869, by Dr. Francis Henry Brown, a Civil War surgeon, who traveled to Europe in 1867 to study the pioneering specialized approach to treating children.[19] Brown was impressed with the treatments he witnessed and he wanted to bring that level of care to Boston. Brown opened a 20-bed facility in a small townhouse at 9 Rutland Street in Boston's South End.[20][21]

Approximately one year after opening, the hospital was moved to the corner of Rutland and Washington Streets. Children's Hospital stayed at this location until 1871 when the hospital moved to Huntington Avenue before its final move to what would become the Longwood Medical and Academic Area.[22][23]

In 1891 Thomas Morgan Rotch, Children's chief physician, established the nation's first laboratory for the modification and production of bacteria-free milk. Before the establishment of this laboratory, breast milk was often the carrier of many deadly diseases[24] that children were especially susceptible to.

Harvard Medical School affiliated itself with Boston Children's in 1903.[25]

Dr. William Ladd, a doctor with Children's, devised procedures for correcting various congenital defects such as intestinal malformations in 1920, launching the specialty of pediatric surgery.[26]

Dr. Robert E. Gross, a surgeon at Children's and later a professor of child surgery at Harvard Medical School,[27] performed the world's first successful surgical procedure to correct a congenital cardiovascular defect with the "ligation of a patent ductus arteriosus"[27] in 1938, ushering in the era of modern pediatric cardiac surgery.

Dr. Sidney Farber, pediatric pathologist, requested Dr. Yellapragada Subbarow (of Lederle lab and his friend and colleague at Harvard Medical School) to supply Aminopterin and later Amethopterin (Methotrexate) to conduct trials on to children with leukemia, a diagnosis that was deemed a "death sentence,"[28] in 1948. He achieved the world's first partial remission of acute leukemia. He went on to co-found the Dana-Farber Cancer Institute in 1950.[29]

Dr. John Enders, his assistant Thomas Weller, and colleague Frederick Robbins, successfully cultured the polio virus in 1949, making possible the development of the Salk and Sabin vaccines for polio. They won the Nobel Prize for their work in 1954. Enders and his team went on to culture the measles virus.

Dr. Judah Folkman published "Tumor angiogenesis: Therapeutic implications" in the 1971 November issue of the New England Journal of Medicine. It was the first paper to describe Folkman's theory that tumors recruit new blood vessels to grow.

The Boston Brace, a new, lower profile brace for patients with scoliosis was developed by Chief of Orthopedics John E. Hall and orthotist Bill Miller at the Boston Children's scoliosis clinic in 1972.[28]

Boston Children's conducted a widespread study on donated teeth from children living in Chelsea and Somerville in the 1970s to study how lead effected children's behavior, development and IQ. The results showed that "children whose teeth had the highest lead levels were far behind those with the lowest on measures including IQ, motor coordination and attentiveness in class."[28]

Hypoplastic left heart syndrome, a defect in which an infant is born without a functioning left ventricle was first treated via surgical palliation in 1983. The procedure was the first to palliate what had been a fatal condition. Three years later, in 1986, Children's surgeons performed the hospital's first heart transplant. Later in the year, a 15-month-old patient became the youngest person in New England to receive a heart transplant.

Boston Children's Chief of Hematology and Oncology David Nathan recommended for Claudia De Pass, a young patient with sickle cell disease, to try Hydroxyurea, a drug used to treat blood cancer, to treat her sickle cell disease. The treatment worked and Hydroxyurea is now broadly used to treat sickle cell disease.[28]

Researchers in neurology and genetics discover the toxicity beta amyloid, a protein that accumulates in the brains of people with Alzheimer's disease, to neurons in 1989. This discovery indicates beta amyloid as the possible cause of the degenerative disease.[30]

Endostatin, one of the most potent inhibitors of blood vessel growth, is discovered by Drs. Michael O'Reilly and Judah Folkman in 1997.[31] In mice, endostatin has shown promise in slowing some cancers to a dormant state. Phase I clinical trials began at three centers in 1999.

Dr. Evan Snyder clones the first neural stem cells from the human central nervous system of a fetus in 1998,[32] offering the possibility of cell replacement and gene therapies for patients with neurodegenerative disease, neural injury or paralysis.

In 1998 Children's establishes its Advanced Fetal Care Center to provide diagnostic services, genetic and obstetrical counseling, and prenatal or immediate postpartum intervention for fetuses with complex birth defects. The same year, Larry Benowitz, PhD grows nerve cells in the damaged spinal cords of rats, a significant step in the treatment of spinal cord injuries. The next year, Benowitz discovers that inosine is important in controlling axon regeneration in nerve cells.[33]

Since 2000[edit]

In 2002 Dr. Scott Pomeroy and Dr. Todd Golub use microarray gene expression profiling to identify different types of brain tumors and predict clinical outcome. This allows radiation and chemotherapy to be tailored to kill cancer cells while leaving healthy tissue alone.[31] Also in 2002, Dr. Nader Rifai helps to author a paper showing that cholesterol levels and LSD use are less accurate predictors of predisposition to strokes and heart attacks then presence of a C-reactive protein that can be found in blood test results.[31]

Dr. Heung Bae Kim and Dr. Tom Jaksic develop, test and successfully perform the world's first serial transverse enteroplasty (STEP) procedure for patients with short bowel syndrome in 2003.[31] The next year, Children's surgeons perform New England's first multi visceral organ transplant when 11-month-old Abdullah Alazemi receives a stomach, pancreas, liver, and small intestine from a single donor.[34]

In 2005, in the best-documented effort to date, Drs. Felix Engel and Mark Keating get adult heart-muscle cells to divide and multiply in mammals, the first step in regenerating heart tissue.[35] Also in 2005, neurosurgeon Benjamin War f brought a technique back to Boston Children's for shuntlesly treating hydrocephalus, the condition of excess fluid around the brain.[28]

In 2006, Dr. Dale Umetsu, Dr. Omid Akbari and colleagues reported that a newly recognized type of immune cell, NKT, may play an important role in causing asthma, even in the absence of conventional T-helper cells. In addition, NKT cells respond to a different class of antigens that are currently recognized to trigger asthma.[31] In that same year, Dr. Larry Benowitz and colleagues discovered a naturally occurring growth factor called oncomodulin that stimulates regeneration in injured optic nerves, raising the possibility of treating blindness due to optic-nerve damage and the hope of achieving similar regeneration in the spinal cord and brain.[31]

Norman Spack co-founds Boston Children's Hospital's Gender Management Service (GeMS) clinic in 2007; it is America's first clinic to treat transgender children.[36][37] The clinic provides " counseling and resources in the years before medical intervention is appropriate, along with psychological support and a stepwise approach to medical treatment."[28]

In order to re-oxygenate blood, Dr. John Kheir and Dr. Tahir Saleem N. Jutt (Cardiac) develop particles that can be injected into a bloodstream in 2012.[38]

In collaboration with Life Technologies, Boston Children's spins out its genetic diagnostic lab in January 2013 to a new firm called Claritas Genomics. The goal of the partnership is to develop genetic and genomic tests for inherited pediatric diseases. Five years later, in January 2018, Claritas ceases operations. The hospital remains Claritas' majority shareholder during its existence, and a Series B funding round was completed in 2015, raising at least US$15 million.[39]

In 2016, the hospital receives approval by the Massachusetts Public Health Council for a $1 billion expansion to the Longwood Medical and Academic Area. The hospital plans to build an 11-story building with 71 new beds, renovate part of the current campus, and build a new outpatient clinic in Brookline, Massachusetts.[40]

Justina Pelletier controversy[edit]

In 2013, Boston Children's Hospital became part of a dispute concerning the treatment of minor Justina Pelletier, which ultimately involved the Massachusetts Department of Children and Families.[41] In February 2012, Pelletier was taken to the emergency-room at Boston Children's Hospital, a trip prompted by severe stomach pain and difficulty walking,[42][43] For a variety of symptoms, Pelletier had previously been taken by her parents to see doctors across multiple states,[44] receiving multiple diagnoses.[45] She had most recently been diagnosed with mitochondrial disease while a patient at Tufts Medical Center.[46] The BCH doctors doubted that difficult-to-confirm diagnosis, owing to the lack of abnormal blood markers and the fact that there had been no finding of an accumulation of mitochondria in the cell membranes of skeletal muscles, often called the “hallmark of mitochondrial disorders".[46] (Dr. Mark Korson, Pelletier's Tufts doctor, had not performed a muscle biopsy.[46]) Dr. Jurriaan Peters, a pediatric neurologist at BCH who evaluated Pelletier, suspected somatoform disorder—a psychological condition creating or worsening physical symptoms.[45][47][48] Moreover, Peters suspected that Pelletier was a victim of factitious disorder by proxy—a form of medical abuse in which parents subject their children to excessive medical care.[45] This suspicion was shared by some of Pelletier's prior doctors.[43] In addition to conversations with Pelletier's past doctors, some of whom shared Peters's suspicion, Peters noted that Pelletier "had multiple diagnoses [and] a very patchy network of providers. Those are all classic red flags.”[45] However, one of Pelletier's former pediatricians, Dr. Thomas Binder, would later state that he never suspected any child abuse.[49]

The Boston Children's Hospital team crafted a treatment plan, with input from some of Pelletier's doctors at Tufts, to "de-medicalize" the case and provide in-hospital psychological care.[45] Although Pelletier's parents were initially receptive, Pelletier's father subsequently attempted to remove Pelletier from the hospital's care, and the team filed a 51A report—used to alert the Massachusetts Department of Children and Families of potential child abuse.[45] Custody of Pelletier was transferred to that agency by order of Judge Joseph Johnston, and the DCF elected to keep her in treatment at Boston Children's Hospital.[50][45][51] Pelletier was held in Boston Children's Hospital's psychiatric ward, Bader 5, from February 14, 2013, until January 2014, when she was transferred to Wayside Youth and Family Support Network, a residential treatment center in Framingham.[52][53][54][55] Reports vary of Pelletier's condition during this stay: Pelletier's father said that Pelletier was "declining" in a way visible "to anyone," while the hospital records reflected Pelletier gaining strength, becoming less reliant on a feeding tube, and having regular bowel movements—something her parents had said was not possible without a tube forcing solution into her intestines to make her colon contract.[56]

The case, covered extensively by the media, sparked public protests and a cyberattack campaign on the hospital by Martin Gottesfeld (who was subsequently criminally charged and convicted).[57][58] In mid 2014, the DCF began allowing Pelletier's parents increasingly expanded visitation rights—including unsupervised day trips,[50] and, on June 6, the agency requested that Pelletier be returned to her parents.[59] On June 17, 2014, Judge Johnston dismissed the child-protection case against the parents, holding that they had successfully demonstrated a "change in circumstances" and noting that they had been cooperative in Pelletier's treatment; the dismissal resulted in the return of Justina to her family.[50] Since her return, Pelletier has undergone multiple medical procedures, including having her colon removed, and the family is currently exploring spinal-related explanations for why Pelletier continues to be unable to walk.[56] The family filed a medical malpractice suit against the hospital, which, after years of litigation, was ultimately resolved in favor of the hospital, after a jury found that Pelletier's doctors had not been negligent.[60][61][43]

Adult programs[edit]

In addition to their pediatric specialties, Boston Children's Hospital serves adults through a couple of their nationally recognized programs. BCH completes adult research in addition to their pediatric research.[62]

  • BCH has one of the largest adult congenital heart disease (ACHD) programs in the U.S., providing congenital cardiac care to every age.[63]
  • Boston Children's Hospital also houses an adult strabismus service that offers comprehensive evaluation and treatment for adults.[64]
  • BCH also houses an adult cystic fibrosis program in collaboration with nearby Brigham & Women's Hospital.[65]
  • BCH houses the maternal fetal care center in collaboration with Brigham & Women's Hospital provides care for mothers carrying babies with congenital anomalies.[66]

Research[edit]

With more than 1,000,000 square feet (93,000 m2) of laboratory space including 58,000 square-feet of clinical research space,[citation needed] the hospital's research enterprise is larger than any other pediatric medical center in the world.[67] Its discoveries have benefited children and adults since 1869.[citation needed] As of 2018, the hospital's research staff included over 3,000 researchers and scientific staff. Boston Children's researchers have been honored as members of the National Academy of Sciences, Institute of Medicine, American Academy of Arts and Sciences, and Howard Hughes Medical Institute.[67] In fiscal year 2018, the hospital reported $338 million spent on research.[citation needed]

Laboratory facilities[edit]

John F. Enders Pediatric Research Laboratories
Named in honor of John Franklin Enders, the Boston Children's Hospital researcher and Nobel laureate who cultured poliovirus and the measles virus.[67]
Karp Family Research Laboratories
This 295,000-square-foot (27,400 m2) building opened in 2003 and increased the hospital's research space by over 60%.[67]
Center for Life Science
Boston Children's Hospital researchers currently occupy more than 4 floors of this 700,000 square-foot, privately-managed research facility

Informatics program[edit]

The Computational Health Informatics Program (CHIP) at Boston Children's Hospital was founded in 1994.[68] The program's research includes several free and open-source software projects.[69]

Stem cell program[edit]

In an effort to support the research community, Children's Stem Cell Program investigator George Q. Daley, M.D., Ph.D., has made dozens of iPS lines developed at Boston Children's Hospital available for use by other scientists through the Harvard Stem Cell Institute.

In 2010, a drug that boosts numbers of blood stem cells, originally discovered in zebrafish in the Boston Children's Hospital laboratory of Leonard I. Zon, M.D., went to clinical trial in patients with leukemia and lymphoma.[citation needed]

Awards[edit]

Nobel Prizes[edit]

Children's Hospital scientist Dr. John Enders and his team were first to successfully culture the polio virus and were awarded the Nobel Prize in Physiology or Medicine in 1954.[70]

Dr. Joseph Murray, chief plastic surgeon at Children's Hospital Boston from 1972 to 1985 was awarded the Nobel Prize in Physiology or Medicine in 1990 for his research on immunosuppression, specifically his "discoveries concerning organ and cell transplantation in the treatment of human disease".[71]

Lasker Awards[edit]

Dr. William Lennox received the Lasker Award[72] in 1951 for his work researching epilepsy.[73] Dr. Lennox organized the American Epilepsy League and the Committee for Public Understanding of Epilepsy.

Dr. Robert Gross received the Lasker Award in 1954 for performing the first operation for patent ductus arteriosus, a congenital heart defect, in 1938.[74] He received an additional Lasker in 1959 for being the first surgeon to graft artery tissue from one person to another in 1958.[75]

Dr. John Enders was awarded the Lasker in 1954, the same year he was awarded the Nobel Prize, for "achievement in the cultivation of the viruses poliomyelitis, mumps, and measles".[73]

Dr. Sidney Farber received the Lasker in 1966 for his 1947 discovery that a combination of aminopterin and methotrexate, both folic acid antagonists, could produce remission in patients with acute leukemia, and for "his constant leadership in the search for chemical agents against cancer".[76]

Dr. Porter W. Anderson, Jr. received the Albert Lasker Clinical Medical Research Award with Dr. David H. Smith in 1996 for groundbreaking work in the development and commercialization of the Hemophilus influenza type B vaccine.[77]

U.S. News & World Report[edit]

In 2016, it was ranked as the best children's hospital in America by U.S. News & World Report and was ranked #1 in cancer, #1 in cardiology, #2 in endocrinology, #1 in gastroenterology and GI surgery, #1 in neonatology, #1 in nephrology, #1 in neurology and neurosurgery, #1 in orthopedics, #2 in pulmonology, and #1 in urology.[78]

In 2021 the hospital was ranked #1 best children's hospital in the United States by U.S. News & World Report on the publications' honor roll list.[79]

As of 2021 Boston Children's has placed nationally in all 10 ranked pediatric specialties on U.S. News & World Report.

2021 U.S. News & World Report rankings for Boston Children's[80]
Specialty Rank (In the U.S.) Score (Out of 100)
Neonatology #6 92.1
Pediatric Cancer #2 99.3
Pediatric Cardiology & Heart Surgery #4 89.9
Pediatric Diabetes & Endocrinology #2 94.7
Pediatric Gastroenterology & GI Surgery #2 99.7
Pediatric Nephrology #1 100.0
Pediatric Neurology & Neurosurgery #1 100.0
Pediatric Orthopedics #2 97.8
Pediatric Pulmonology & Lung Surgery #1 100.0
Pediatric Urology #1 100.0

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