Department of Pediatrics

History

The Department of Pediatrics was established in 1960, with William Gene Klingberg, M.D., as its first chair. The department was originally envisioned as a small department to meet the basic pediatric educational needs for the School of Medicine as well as basic Patient Care for West Virginians. Over the last four decades the Pediatric department has grown to include one of the best clerkship rotations of the SOM as well as providing care in a full‑service children's hospital, a busy pediatric and adolescent clinic, and a large number of referral and outreach clinics throughout the state. The Department is quite proud of the quality of teaching, Patient Care and research being accomplished by his faculty members and staff.

Education:

In the early 1970s, the need for a comprehensive general outpatient service led to establishment of the Pediatric Group Practice (PGP), one of the first programs of its kind in a teaching institution. The education of medical students and residents in an out-patient setting have improved from the pediatric and adolescent clinic growing from a six examination rooms area to ten rooms with its’ own nursing personnel. In 2003, the clinic was remodeled to expand to 40 exam rooms. PAGP (Pediatric and Adolescent Group Practice) continues to emphasize ongoing care of the well child, regular immunizations, monitoring the child's development, and educating parents in preventive medicine. Subspecialty clinic rooms went from being six rooms shared by adult neurology to thirteen rooms dedicated to only pediatrics with their own nursing personnel. In addition to providing training experience to medical students and residents, the practice has served the primary care needs of many children and has increasingly served as a referral center.

Originally, third year medical students spent 12 weeks on the pediatric clinical clerkships. The time was later reduced to eight weeks: six weeks on the inpatient service and two weeks on the outpatient service. As patient care shifted more to the outpatient setting, that component of the clerkship became more important, and in 1988 the third year rotation changed to four weeks on inpatient and four weeks on outpatient service.

A pediatric residency training program was approved in 1961. Over the years, the primary shift in training has been toward greater emphasis on the total development of the child rather than illnesses alone. This shift has also led to greater involvement of non‑medical people such as psychologists, social workers, and nurse educators in the teaching program. In 1981, a combined medicine/pediatric residency program was instituted, making West Virginia University only the third institution in the United States to begin such a program. By 1988, there were approximately 80 medicine/pediatrics residency training programs in the United States. The School of Medicine's program, which has received national attention, has the lowest attrition rate of any similar program in the country. We are proud that one of our Med/Peds graduates has received national recognition from COMSEP for design and implementation of a board game for medical students entitled “The Pediatric Board Game”.

Patient Care:

The department expanded its faculty to meet the requirements of a children's hospital, providing the full range of services, including allergy/immunology, cardiology, child development, critical care, cystic fibrosis, endocrinology, adolescent medicine, gastroenterology, genetics and metabolic disease, hematology/oncology, neonatology, nephrology, neurology, and apnea evaluation. Services provided by faculty with joint appointments include ophthalmology, urology, orthopedics, psychiatry, surgery, and cardiothoracic surgery.

The inpatient service originally consisted of a 25‑bed unit in the original University Hospital; but it quickly grew to 39 beds. Later, the service moved to a 50‑bed unit on the sixth floor plus 22 newborn bassinets. During the 1970's development of newborn intensive care and step-down units were added. With the opening of Ruby Memorial Hospital in 1988, the new "Children's Hospital" brought a major step forward in the care of seriously ill children by the addition of a 10-bed pediatric intensive care unit. Children's Hospital, which occupies the entire sixth floor of Ruby Memorial Hospital combines the maternal-child health services. It now comprises 30-ward beds with 5 step-down beds, 30 NICU beds with 10 step-down beds. There is a fully equipped newborn nursery.

Parents are encouraged to be involved in the care of their children, and the department tries to accommodate parents who want to stay in the hospital with their child. To serve the needs of families who must travel a great distance to Morgantown, the department initiated construction of a Ronald McDonald House in 1989.

In the l980’s monthly outreach clinics in pediatric cardiology and genetics were initiated. Today we continue outreach clinics in those areas as well as pediatric neurology, endocrinology and neurosurgery. Clinics are held in Martinsburg, Wheeling, Parkersburg, Huntington, Charleston, and Beckley.

Research:

The Department of Pediatrics remains actively involved in both clinical and basic science research focused on helping children and adolescents live better and healthier lives. In addition, Pediatric faculty collaborate with both internal and external investigators to deliver community based interventions to the citizens in West Virginia.

The department's research projects over the years have been varied and have grown as the faculty expanded into new arenas. Some of the first was Dr. Barbara Jones's research on pediatric leukemia and solid tumors. Today the Section of Pediatric Hematology/Oncology is actively involved in clinical research primarily through our participation in the Pediatric Oncology Group. This large, multi-institutional cooperative group has been a leader in developing effective therapy for children with a wide variety of malignant disorders. In fact, participation in open research protocols represent the state of the art in pediatric cancer care.

Dr. Steve Amato, the department’s first full time clinical geneticist, studied prenatal genetic diagnosis and population genetics, which provided cytogenetic laboratory expertise for West Virginia. Today we have genetics outreach clinics in six different locations to help diagnose and treat genetic disorders.

During the 1980's research projects included amino acid metabolism in the developing fetus by Edward Liechty, M.D.; exogenous surfactant administration to premature infants with hyaline membrane disease by Dr. Martha Mullett; pharmacologic closure of the ductus arterious with indomethacin collaborated by Drs. Neal and Mullett; and the Sudden Infant Death Prevention Project through the state chapter of the American Academy of Pediatrics by Dr. David Myerberg. Today research continues with Dr. Mark Polak and collaborators being involved in a variety of studies including long term follow up of infants born to mothers with HELLP syndrome, long term follow up of infants with pulmonary hypertension, and NOS activity in rat lungs exposed to NMDA. Dr. Susan Lynch is focused on the effects of "swaddling on oxygen saturation and behavioral state in infants with chronic lung disease, and on investigation of the effects of prophylactic rhG-CSF on the incidence of nosocomial sepsis in prolonged pre-eclampsia associated neutropenia.

Dr. Laura Gibson, a former student and now faculty member and mentor is in charge of bench research. Her laboratory is studying acute lymphoblastic leukemia (ALL) which accounts for 80% of leukemias in pediatric patients. While treatment strategies have improved in recent years, it is estimated that 20% of children relapse with leukemic disease following standard therapy. The group of children that have resistant disease typically have a very poor prognosis, and tend not to respond well to additional therapy. The poor outcome associated with leukemic relapse makes it essential to better understand the factors that contribute to survival of leukemic cells during chemotherapy. One focus of her laboratory is to investigate methods to disrupt survival signals provided by the bone marrow, with the long-term goal being the development of strategies that make leukemic cells more susceptible to chemotherapy. Her laboratory includes physicians, graduate students, and post doctoral fellows in training.

Dr. Nevin Wilson and Dr. Mary Beth Hogan conduct studies in asthma as a disease that affects all age groups, but the highest incidence occurs during childhood. Hospital admissions and deaths from asthma have been increasing over the last 20 years. West Virginia has one of the highest asthma rates and on of the highest death rates in the country due to this disease. Hospitalization rates for children in West Virginia are well above average when compared to the rest of the United States. Very little information is available on asthma triggers or medication use which is immediately applicable to the rural children in the state of West Virginia. They conduct asthma studies involving triggers relevant to West Virginia, asthma medication adherence studies and laboratory research involving the role of eosinophil precursors on the pathophysiology of asthma.

Dr. William Neal developed the nationally recognized Coronary Artery Risk Detection in Appalachian Communities (CARDIAC) Project has been designed to address the unacceptably high morbidity and mortality from cardiovascular disease in West Virginia. West Virginia is the second most rural state in the nation, with two-thirds of its 1.8 million people living in communities of less than 2,500 population. Compared to other states, West Virginia currently has the highest rate of obesity, the third highest rate of self-reported hypertension, and the fifth highest rate of cigarette smoking.

Dr. Lesley Cottrell focuses on the nature and magnitude of the relation between parenting practices and infant/adolescent development. She has been examining the effects of maternal and paternal sleep disruption on parent well being and functioning as well as parental perceptions of the infant and infant development. The second approach to examining parenting practices focuses on the relation between parenting practices (e.g., monitoring) and adolescent health behaviors.

The Adolescent Medicine Section is working on baseline studies on exhaled carbon monoxide in smokers and non-smokers; as well as tobacco prevention strategies.

The department's involvement in state wide health care programs, often in cooperation with the Department of Health and Human Services and the Department of Education, has contributed to outreach in other areas. Since the 1960s the department continues to organize summer camps for children who have cystic fibrosis, heart disease, diabetes and cancer with comprehensive medical consultation and education about general health, diet, monitoring of life styles, insulin administration, and physical activities.

Conclusion:

There is no doubt that the Department has come a long way in four decades. Our faculty, staff and infrastructure are dedicated to serving infants, children, and adolescents and their families. We create an environment that promotes healthy development, provides reassurance and comfort, fosters healing, and enables our young patients to maintain a primary focus on their lives as children and students rather than on their disease or impairment. By educating both the current and future generations of child health providers, we promote the development of excellent clinical skills, humanistic qualities, and commitment to professionalism.