Research

The Division of Pediatric Surgery at DMC Children’s Hospital of Michigan has an active research program in Clinical Outcomes, Quality Improvement and Translational Sciences. The Translational sciences research is in conjunction with the School of Engineering at Wayne State University. The Pediatric Surgery faculty within the division mentor Pediatric Surgery Fellows, Critical Care Fellows, a Resident Research Scholar, General Surgery residents, nurses and medical students across a host of ongoing projects.  The projects cross all areas of Pediatric Surgery including neonatal and congenital diseases, treatment modalities, trauma, burn, ECMO outcomes and haptics engineering for minimally invasive surgery as well as the utilization of Raman spectroscopy in diagnostic evaluations.
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RESEARCH

CLINICAL OUTCOMES

Necrotizing Enterocolitis (NEC)

Necrotizing enterocolitis is gangrene or the death of intestinal tissue. It occurs when the lining of the intestinal wall dies and the tissue falls off. The cause for this disorder is unknown. However, it is thought that a decrease in blood flow to the bowel keeps the bowel from producing mucus that protects the gastrointestinal tract.

Appropriate timing of stoma reversal in neonates with NEC
When NEC has progressed full to gangrene of the intestine, that portion must be excised.  Since it is dangerous to reconnect the bowel immediately, we bring out “stomas”.  These are sometimes called “a colostomy” of “wearing a bag”.  This study will allow us to decide when it is most safe to reconnect the bowel and do away with the stomas.

  • Principal Investigator: Michael D. Klein, M.D.
  • Study is in progress.

Conservative management for NEC, ideal duration of treatment 
Study investigates the shortest length of time required to medically treat NEC when the bowel has been injured, but is not yet dead.

  • Principal Investigator: Raquel Gonzalez, M.D.
  • Faculty Investigator: Joseph Lelli, M.D.
  • Study is in progress.

Improving timing of surgical intervention in NEC

Study investigates if using measures of metabolic derangement can provide a more accurate time to perform surgical intervention for NEC.

  • Principal Investigator: Michael D. Klein, M.D.
  • Resident Research Scholar: Anthony Munaco, MD
  • Study is in progress.

Total parenteral nutrition (TPN) associated cholestasis in NEC
Study investigates if there is a relationship between the development of cholestatic jaundice and the nature (quantity, content, and duration) of parenteral feeds in the neonate with a diagnosis of NEC.

  • Principal Investigator: Michael D. Klein, M.D.
  • Resident Research Scholar: Anthony Munaco, MD
  • Study is in progress.

Comparing peripherally inserted central catheter to centrally inserted venous catheter use in NEC

Study investigates if there is any difference in sepsis rates between centrally vs. peripherally inserted catheters in NEC patients.

  • Principal Investigator: Michael D. Klein, M.D.
  • Resident Research Scholar: Anthony Munaco, MD
  • Study is in progress.

Congenital Diaphragmatic Hernia (CDH)

A congenital diaphragmatic hernia is when there is an absence of a child’s diaphragm or a hole in their diaphragm.  It is associated with very small lungs, and even with the best treatment, survival may be only 50%.

Comparative analysis of early vs. delayed repair of CDH
Since 2009, the Pediatric Surgery group at DMC Children's Hospital of Michigan has shifted practice to early surgical repair.  This study investigates the outcomes in patients who underwent early repair compared with those who had historically undergone delayed repair.

  • Principal Investigator: Joseph Lelli, M.D.
  • Faculty Investigators: Raquel Gonzalez, M.D., Lydia Donoghue, M.D., Scott E. Langenburg, M.D.
  • Resident Research Scholar: Anthony Munaco, MD
  • Study complete.
  • Manuscript submitted to the Journal of Pediatric Surgery (JPS)

Prospective, Randomized Multicenter Clinical Trial: Early vs Delayed Repair of CDH
Grant submission in progress to conduct a Multicenter Clinical Trial of Early vs. Delayed Repair of CDH.

  • Principal Investigator:  Raquel Gonzalez, MD.
  • Faculty Investigator: Joseph L. Lelli Jr. MD.

Extracorporeal Membrane Oxygenation (ECMO)

Extracorporeal membrane oxygenation (ECMO) is a treatment modality that uses a pump to circulate blood through an artificial lung and return oxygenated blood into the bloodstream. This system provides heart-lung bypass support outside of the body.

Ideal Duration of an ECMO trial, Is There Consensus?
Given the lack of evidenced-based data nationally on the ideal time to trial off a patient on ECMO, this study investigates our current practice and its efficacy in determining readiness to come off  ECMO support.

  • Principal Investigator:  Raquel Gonzalez, MD
  • Faculty Investigator:  Joseph Lelli, M.D.
  • Resident Research Scholars: Kartheek Nagappala, MD & Anthony Munaco, MD
  • Study is in progress.

Use of Antibiotic Prophylaxis during ECMO Support and the Incidence of Catheter-Associated Bloodstream Infections

Study investigates if the use of antibiotics during ECMO support affects the incidence of Catheter-Associated Bloodstream infections.

  • Principal Investigator:  Raquel Gonzalez, M.D.
  • Faculty Investigators:  Scott Langenburg, M.D., Joseph L. Lelli, MD
  • Study is complete. 
  • Manuscript in progress

Trauma

The Trauma program actively investigates injury outcomes, injury detection methods and effectiveness of injury prevention programs.

The predictive value of 
ALT and AST in pediatric liver trauma

Study investigates if the ALT and AST lab values are good predictors of liver trauma.

  • Principal Investigator:  Scott Langenburg, M.D.
  • Resident Research Scholar: Anthony Munaco, MD
  • Study is in progress.

The predictive value of amylase and lipase in abdominal trauma
Study investigates if the amylase and lipase lab values are good predictors of abdominal trauma.

  • Principal Investigator:  Scott Langenburg, M.D.
  • Resident Research Scholar: Anthony Munaco, MD
  • Study is in progress.

Effectiveness of classroom injury prevention education in the elementary school population
Study compares the level of injury prevention knowledge via tests pre and post educational presentations.

  • Principal  Investigator:  Sue Jane Smith, MSN
  • Study is in progress.

Effectiveness of classroom health and injury prevention education on the knowledge base of expectant mothers

Study compares the level of health and prevention knowledge via tests pre and post educational presentations.  Expectant mothers in their 8th month of pregnancy attend a 4-5 hour class to learn how to get their baby home safe and keep them safe for one month.  Mothers are taught nutrition, fire and burn prevention, child passenger safety, safe sleep, CPR and there is a discussion about what do you do when your baby will not stop crying.

  • Principal Investigator:  Sue Jane Smith, MSN
  • Study is in progress.

Effectiveness of child passenger safety education at a car seat check
Study compares the level of child passenger safety knowledge of the adult driver via tests pre and post child passenger safety education at a car seat check.

  • Principal Investigator:  Sue Jane Smith, MSN
  • Study is in progress.

Effectiveness of fire safety education during smoke alarm installation home visits

Study compares the level of fire safety knowledge six months following a smoke alarm installation home visit and at a follow-up visit within the first year following the installation.

  • Principal Investigator:  Sue Jane Smith, MSN
  • Study is in progress.

Burns

Does fever predict the need for split-thickness skin graft in scald burns
Study investigates if the patients who are febrile with a temperature over 38 degrees Celsius after scald burns are more likely to require a split-thickness skin graft to heal their injury.

  • Principal Investigator:  Christina Shanti, M.D.
  • Faculty Investigator:  Joseph Lelli, M.D.
  • Study is complete. 
  • Manuscript is in preparation.

Use of Joy dish washing soap and  tap water for burn debridement and dressing changes
Study investigates if the use of joy soap and tap water in the debridement and cleaning of a burn wound leads to an increase of infections in the pediatric burn population.

  • Principal Investigator:  Christina Shanti, M.D.
  • Nursing Investigator:  Heather Schaewe, MSN
  • Study is in progress.

Comparison of Sink and Bathtub burns in Children: Implications of Abuse and an opportunity for teaching and prevention 
Study investigates the incidence of pediatric scald burns incurred while bathing and whether the mechanism predicts a nonaccidental injury.  There is also an opportunity to teach parents that when bathing their child in the sink they need to take special precautions.

  • Principal Investigator:  Christina Shanti, M.D.
  • Faculty Investigator: Raquel Gonzalez, M.D.
  • Study is completed. 
  • Manuscript in progress.

Routine Use of Urinalysis in Pediatric Burn Patients: When is it Indicated?
The use of urinalysis as part of the initial work-up of pediatric burn patients has been a routine practice at our institution.  The study investigates if this routine practice is actually necessary.

  • Principal Investigator:  Christina Shanti, M.D.
  • Faculty Investigator: Raquel Gonzalez, M.D.
  • Study is complete.  
    • Manuscript in preparation.

Epidemiology and Profile of Pediatric Burns in a Large Referral Center
Study reviews the admissions to the Children’s Hospital of Michigan Burn Center to determine mechanism, depth of burn, size of burn and analyzes the data.

  • Principal Investigator:  Ami Shah, MD
  • Nursing Investigator: Sue Jane Smith, RN, MSN
  • Study is complete. 

Use of a rapid triage and admission algorithm improves ER Department flow, decreases operating costs, and improves patient care for pediatric burn patients.
To determine if adopting an algorithm for rapid triage and admission of burn patients to a closed burn unit can decrease patient boarding times in the emergency room, expedite the delivery of pain medications and decrease operational costs, all while providing excellent, if not improved, clinical care.

  • Principal Investigator: Russell Radtke, MD
  • Nursing Investigator: Heather Schaewe, RN, MSN
  • Study is complete. 
  • Manuscript awaiting acceptance.

Use of pinless halo for positioning patients with severe neck burns
The pinless halo system presents an effective, non-invasive option to the burn therapist in meeting the rehabilitative needs of their patients with severe neck burns.

  • Principal Investigator: Christina Shanti, M.D.
  • Nursing Investigator: Heather Schaewe, RN, MSN
  • Rehabilitation Investigator: Beth Angst, OTR/L
  • Study is in progress.

Study of parental satisfaction with the outcome of their child’s burn care at the Children's Hospital of Michigan
The goal of this study is to determine parental satisfaction with the outcome of their child’s medical care on the inpatient unit and outpatient clinic.

  • Principal Investigator: Dave Allasio, MSW
  • Faculty Investigator: Christina Shanti, M. D., Joseph Lelli, M.D.
  • Study is in progress.

Pattern of contact burns from falling irons
The goal of this study is to determine if a falling clothes iron could produce a burn on a standing child. The hypothesis of the study is that falling clothes irons do not hit children with the hot surface of the iron and therefore do not cause burns.

  • Principal Investigator: Dave Allasio, MSW
  • Faculty Investigator: Christina Shanti, M. D., Joseph Lelli, M.D.
  • Study is in progress.

Human blood abrogates the antimicrobial effect of Silver Sulfadizine
Looking at the effectiveness of the antimicrobial component of Silvadene when blood is present in burn wounds. 

  • Principal Investigator: Christina Shanti, M. D.
  • Study is completed.
  • Manuscript in preparation.

Does 90 day storage of Silver Sulfadizine (Silvadene) coated gauze lessens its antibacterial qualities?
This study looks at the stability of Silvadene when impregnated in sterile Kerlix.

  • Principal Investigator: Christina Shanti, M. D.
  • Study is completed.
  • Manuscript in preparation.

QUALITY IMPROVEMENT

NATIONAL SURGERY QUALITY IMPROVEMENT PROGRAM (NSQIP)

The National Surgery Quality Improvement Program is a Multicenter program that provides risk adjusted outcomes for children’s hospitals and allows comparison to other institutions.  The program is at the Beta Development stage and the Children’s Hospital of Michigan is one of 30 children’s hospitals participating in the development of the program.

Development of quality improvement measures for a Pediatric Surgery Department using NSQIP outcome measures

  • Principal Investigator:  Lydia Donoghue, MD.
  • Faculty: Joseph L. Lelli Jr. MD
  • Resident Research Scholar: Anthony Munaco, MD
  • Study is in progress.

Development of and outcomes to resource utilization ratio for measuring the effectiveness of treating appendicitis

  • Principal Investigator: Joseph L. Lelli Jr. MD.
  • Faculty Investigator: Lydia Donoghue MD.
  • Study is in progress.

TRANSLATIONAL SCIENCES

Raman Spectroscopy

Raman spectroscopy is a spectroscopic technique used to study vibrational, rotational, and other low-frequency modes in a system. It relies on inelastic scattering, or Raman scattering, of monochromatic light, usually from a laser in the visible, near infrared, or near ultraviolet range. The in the energy of the laser photons being shifted up or down. The shift in energy gives information about the vibrational modes in the system. Infrared spectroscopy yields similar, but complementary, information.

 
Raman spectroscopy of pediatric neoplasms
Study will investigate the various Raman spectroscopic signals associated with normal and malignant variations of different pediatric tissues.

  • Principal Investigator: Michael Klein, M.D.
  • Study is in progress.

Raman spectroscopy use in the diagnosis of Hirschsprung’s 
Study will investigate the use of Raman spectra to identify the difference between normal and aganglionic mucosa in a less invasive manner and more rapidly than rectal biopsy with special staining requiring pathologists with special expertise (current method).

  • Principal Investigator: Michael Klein, M.D.
  • Resident Research Scholar: Anthony Munaco, MD
  • Study is in progress.

Raman spectroscopy use in the diagnosis of burns and skin lesions
Study will investigate the use of Raman spectra in identifying the depth of burned skin and the depth of skin lesions.  Currently pilot studies with pathology specimens are being done.

  • Principal Investigator: Michael Klein, M.D.
  • Study is in progress.

Raman spectroscopy use in the detection of bacteria

Study will investigate the use of Raman spectra in identifying the presence of bacteria.

  • Principal Investigator: Michael Klein, M.D.
  • Study is in progress.

 Screening, Brief Intervention and Referral to Treatment (SBIRT)

Past studies have shown that alcohol is a major factor in the incidence of trauma.  Also, research has shown there is an opportunity during hospitalization to assist people with an alcohol problem to be identified and referred for treatment. SBIRT is a comprehensive approach that utilizes universal alcohol and drug screening to provide early intervention and treatment to adolescents with risky alcohol use. 

Review of SBIRT implementation (Multi-Center Study)
Study will investigate how SBIRT services are currently being implemented and how SBIRT technical assistance components affect implementation.

  • Principal Investigator: Scott Langenburg, M.D.
  • Nursing Investigators: Donica Kulwicki, MSN, Heather Schaewe, MSN, Sue Jane Smith, MSN
  • Study is in progress.

Other:

Can Pectus Excavatum be treated with a vacuum bell?  
Pectus excavatum, also known as sunken or funnel chest, is a congenital chest wall deformity in which several ribs and the sternum grow abnormally, producing a concave, or caved-in, appearance in the anterior chest wall.

  • Principal Investigator: Michael Klein, M.D.
  • Study is in progress.

Automated Laparoscopic Camera
Equipment is being invented and human factors studied determine mechanics of manipulation of the automated Laparoscopic camera.

  • Principal Investigator: Michael Klein, M.D.
  • Study is in progress.
Our experts are actively involved in research, working hard to improve diagnosis and treatments.
Our experts are actively involved in research, working hard to improve diagnosis and treatments.