Multidisciplinary teams at Dell Pediatric Research Institute focus on birth defects, cancer, prematurity and improving emergency care.
AUSTIN, Texas — The Dell Pediatric Research Institute works toward a singular mission of meeting the needs of children and families of Central Texas with evidence-based, cutting-edge care. Managed by Dell Medical School, DPRI plays an important role in facilitating collaboration among interdisciplinary teams of clinicians and scientists from Dell Med and across The University of Texas at Austin — all with a focus on improving children’s health and pediatric care.
“Our ‘North Star’ is taking care of children in Austin, making sure they have access to all the care they need right here at home,” said Leah Harris, director of DPRI and chair of the Department of Pediatrics at Dell Med. “The way that you make clinical care cutting edge is by infusing it with an academic infrastructure. That’s where Dell Med and UT Austin come in — we bring together the experts who provide the evidence that informs care.”
Harris, who is also interim president and physician-in-chief at Dell Children’s Medical Center, describes the institute as a “one-stop shop,” uniting dozens of investigators across disciplines who are focused on major causes of death and morbidity in children: poor nutrition, cancer, birth defects and rare diseases, as well as studying how care is delivered to children who show up at emergency departments. Future investment and focus will also include developing a genomics institute that will allow for expanded precision medicine research that uses genetics and genomics to customize care for individuals, she said.
Launched in 2010 and located across the street from Dell Children’s Medical Center, DPRI was created with a $38 million challenge grant from the Michael & Susan Dell Foundation, aimed at growing and developing a full pediatric ecosystem in Central Texas.
Improving Quality of Emergency Care for Children
Nationwide, more than 80% of children who need emergency care are treated at general emergency departments instead of specialized pediatric facilities. Research shows most of those emergency rooms, or ERs, are not well prepared to meet the unique needs of children.
Katherine Remick, M.D., is working to change that. She leads the national Emergency Medical Services for Children Innovation and Improvement Center, a federally funded program co-led by Dell Med that aims to improve health care outcomes for children in emergency settings.
Our goal is to help every emergency department in the country to fully integrate the needs of children into their everyday practice.
Katherine Remick, M.D.
“There’s as much as a fourfold decrease in mortality for critically ill and injured children who go to emergency departments that are well prepared to treat kids,” said Remick, who is also an associate professor in the Dell Med departments of Pediatrics as well as Surgery and Perioperative Care and a care provider at Dell Children’s. “Our goal is to help every emergency department in the country to fully integrate the needs of children into their everyday practice.”
To do this, Remick and her collaborators from across the country engage front-line emergency care teams and offer them evidence-based resources to implement changes and improvements in pediatric emergency care — such as how to assess pain in children or how to manage care for kids during pandemics.
“By actively helping to implement these quality improvement methods, we can change an entire system of care in less than three to five years — far faster than it would take if we simply provided guidelines and left emergency care teams to integrate changes on their own,” said Remick.
Importantly, this work is scalable, replicable and measurable. In that context, Remick and her team are working to develop a national quality improvement data registry that provides a platform for all emergency departments, including those in rural and remote areas, to engage in pediatric quality improvement efforts.
Focus on Nutrition and Closing Food Insecurity Gaps
Megan Gray, M.D., MPH, is a community pediatrician whose research at DPRI focuses on early-life nutrition. In her clinical work at the North Central branch of CommUnityCare Health Centers, she serves mostly immigrant families and helps to connect them with food resources in Travis County.
The best systemic things you can do for obesity prevention stem from supporting families … It’s all interconnected.
Megan Gray, M.D.
“This population is already vulnerable because they are recently arrived, may not have established connections in the community and are living with the constant fear of deportation,” said Gray, who is also an assistant professor of pediatrics at Dell Med. “When it comes to food insecurity, that has been the greatest challenge: trying to identify the families that need help and then finding the right messengers to dispel some of that stigma and fear.”
Hand in hand with food insecurity are health problems that arise from what nutritionists call a “monotony of diet,” eating the same often high-calorie, low-nutrient foods, Gray said. Additionally, the threat of food scarcity can lead to disordered eating behaviors, and children may end up with obesity and other issues that can follow them into adulthood.
In her work with other researchers at UT’s Department of Nutritional Sciences, Gray says she’s seeing troubling patterns of type 2 diabetes, high cholesterol, liver disease and obstructive sleep apnea among patients as young as 9 years old. To combat this, Gray is focused on obesity prevention, especially in the critical “First Thousand Days” of life, where healthy nutrition has an outsize impact.
She was recently awarded the American Diabetes Association Junior Faculty Award to examine sleep and feeding in this age group, tracking infant sleep through accelerometers, and helping teach sensitive infant feeding in group visits at CommUnityCare.
An upstream focus of Gray’s research is examining how intergenerational obesity and food insecurity connect, and how to stop the unhealthy cycle.
“The best systemic things you can do for obesity prevention stem from supporting families through programs like parental leave, paid child care, living wages so families don’t have to work multiple jobs — anything that would relieve stress for parents, and any kind of food support. It’s all interconnected,” said Gray.
Rethinking the Fight Against Pediatric Cancers
The research John Powers, Ph.D., is doing at DPRI has a simple but potentially groundbreaking goal: to make cancer therapies less toxic for kids.
“Pediatric patients are treated with chemotherapy and radiation — toxic agents that can save their lives. But that treatment also leaves their bodies damaged,” said Powers, who splits his time between DPRI research and teaching at Dell Med as an assistant professor of pediatrics. “We call these ‘survivorship issues,’ and though these problems can affect adults too, the damage to children is much more profound.”
Powers’ lab is looking at two alternatives to traditional pediatric cancer treatments. He and his team, which includes researchers at UT’s College of Pharmacy, are working to understand the roles that different types of RNA play in cancer development to ultimately create new therapies, including for pediatric neuroblastoma, a type of brain tumor mainly affecting kids age 5 and younger. This work focuses partly on targeting special “small RNA” molecules to limit cancer cells’ actions.
Powers is also pursuing a platform for personalized cancer vaccines that use a patient’s own cancer mutation profile to target the person’s specific disease. This approach will trigger the body’s own immune system to attack and eliminate tumors.
“Both of these approaches are likely far less toxic than chemotherapy and other genotoxic treatments that remain part of the standard of care for many cancers,” said Powers. “We hope they will eventually be used for adults too.”
Genomics: The Next Frontier of Pediatric Care
Looking ahead, Harris says DPRI will invest more in translational research efforts, particularly in the areas of genomics — the study of a person’s genes and the interaction of those genes with one another and a person’s environment.
“We are now moving into an age when precision medicine is the key to treating children who have diseases caused by gene defects, gene-environment interactions and growth disorders,” said Harris. “In this era of gene editing therapy, we are even seeing the ability to not only target the disease by changing the patient’s genes, but also targeting therapy the same way. It’s a beautiful collaboration between clinical care, research, pharmacy, nutrition and pediatrics since so much of these therapies are going to involve all of us.”