Looking Out for the Littlest Patients



Looking Out for the Littlest Patients
A Q&A with Judy L. Aschner, M.D.

Dr. Aschner is the physician-in-chief at Children’s Hospital at Montefiore (CHAM) and professor and Michael I. Cohen, M.D., University Chair of Pediatrics at Einstein. She is an internationally recognized leader and physician-scientist in pediatrics, neonatology and perinatal biology whose research has helped reveal factors that contribute to altered lung development and pulmonary hypertension in infants with lung and heart disease. As chair of the department of pediatrics, Dr. Aschner has overall responsibility for its patient care, research, advocacy and educational missions. Last September, the National Institutes of Health awarded Dr. Aschner a $6.13 million grant to direct a multicenter study of one thousand children cared for in neonatal intensive care units (NICUs) after birth. The study will follow the children up to age 10 to see if environmental exposures in the NICU—particularly to plasticizers called phthalates and to metals such as manganese—influence lung health, growth, development, behavior and other outcomes.

“Montefiore attracts healthcare providers who could have chosen other well-known institutions but who believe in our mission and are committed to our community and to the people within it.”

How did you become a pediatrician?
I was one of those medical students who liked every rotation—while on medicine I wanted to do medicine, and the same for obstetrics and surgery. But during my pediatrics rotation I fell in love. It was just the right fit, yet I resisted it at first. During the late 1970s, if you were a female medical student, there was this expectation that you’d become a pediatrician. I fight against all expectations, so I tried to talk myself out of it for a long time. Finally I realized I’d just be shooting myself in the foot to do anything else, since pediatrics was where my passion was and where I felt I could make the biggest difference.

Why neonatology as a specialty?
My first child was born the day after I graduated from medical school, so I didn’t start my pediatric internship until six months later. That experience of taking care of my child every day at home helped me feel immediately comfortable in the NICU, despite all the technology and how sick and small some of the babies were. By the time I did my second NICU rotation, I was smitten—I loved the need to make quick decisions, the immediate gratification you get and mastering the skills required in an intensive care setting.

What motivated you to come to Montefiore?
For nearly a decade I was at Vanderbilt, where I’d been recruited to be chief of neonatology. I’d drawn up two five-year plans, and after six or seven years I’d achieved most everything I’d set out to do. I felt I had one more big job left in me and realized that the platform of a pediatric chair would allow me to build and grow really meaningful programs. As I began exploring that option, the social justice mission at Montefiore was crucial in my decision to accept the position here, a little over four years ago.

How important is the close partnership between Einstein and Montefiore to your work?
It’s critical. I see my department as the poster child for what synergies between the institutions should look like. A great example on the clinical front is the Montefiore-Einstein Regional Center for 22q11.2 Deletion Syndrome on the Montefiore Hutchinson Campus, chosen for its proximity to Einstein. It cares for children with a genetic condition called 22q11 deletion syndrome (22q11DS) and was driven by the expertise and research of Bernice Morrow, Ph.D., professor of genetics at Einstein. Children with 22q11DS often have numerous health problems, and the clinic is a really strong collaboration among the departments of genetics and pediatrics with specialists in cardiology, psychiatry, immunology, genetic medicine, speech and language therapy. Children see three or four providers from different subspecialties with one clinic visit. Patients and their families realize they are getting comprehensive care. We’ve now established many of these multidisciplinary clinics at CHAM.

What about research synergies?
Recently, my department and Einstein’s neuroscience chair, Kamran Khodakhah, Ph.D., jointly recruited Praveen Ballabh, M.D., a neonatologist and neuroscientist who works in the NICU but spends most of his time in his lab at the Kennedy Center. He’s using a rabbit model to study how to prevent the long-term neurological morbidity associated with intraventricular hemorrhage—bleeding inside or around the brain’s ventricles. It’s a major complication of prematurity that affects about 12,000 babies each year in the U.S. He has started taking some of his bench discoveries into the clinical arena to see whether they’ll work there. I hope this will be the first of many joint research recruitments.

Why should people go to Montefiore for pediatric care rather than to competing institutions?
I don’t think any hospital in the area has faculty and staff as talented, committed and compassionate as we have at CHAM. And then there’s the culture here at Montefiore. It attracts healthcare providers who could have chosen other well-known institutions but who believe in our mission and are committed to our community and to the people within it. I like to say that at Montefiore we create a medical home for our children and our families and an academic home for our faculty and trainees