Research Articles

Below is a list of research articles published in peer-reviewed journals by CHKD-affiliated pediatricians, pediatric subspecialists, pediatric nurses, and other clinicians, sometimes in collaboration with resident physicians and researchers affiliated with Eastern Virginia Medical School, CHKD’s academic partner.

Children’s Health System is committed to the highest ethical and legal standards in the practice of medicine and research. To safeguard the objectivity of our research activities, CHS has a conflict of interest policy in accordance with federal guidelines. This policy is in place to ensure that the design, conduct and reporting of research funded under Public Health Service grants, agreements and contracts is free from bias that may result from an investigator’s financial conflict of interest. Read the policy here.


January 2014
Epidemiology of Bacteremia in Febrile Infants in the United States
CHKD-affiliated author(s): Dr. Rianna Evans

This was a retrospective, multi-center chart review of positive blood cultures in febrile infants. The review identified 181 positive blood cultures from 6 centers and found the most common pathogen to be E. coli, followed by group B Streptococcus. There were no cases of Listeria monocytogenes detected, prompting discussion regarding the choice of empiric antibiotic therapy in this population.

May 2013
Short-term gestation, long-term risk: prematurity and chronic kidney disease
CHKD-affiliated author(s): J. Bryan Carmody

This article reviews the theory, experimental evidence, and epidemiologic data that suggest an increased long-term risk for chronic kidney disease among infants born prematurely, and presents a risk-based screening algorithm for pediatricians following these patients after their discharge from the NICU.

URL: Additional Information
October 2012
The Laryngoscope
Current use of intralesional cidofovir for recurrent respiratory papillomatosis
CHKD-affiliated author(s): Dr. Craig Derkay

This research involving interviews of 82 surgeons who manage 3,043 patients with a disease of the respiratory tract caused by the Human Papilloma Virus recommends an antiviral medication, cidofovir, as an adjunct to surgery in cases that require repeated surgical intervention.


Clinical Pediatrics
Screening Children for Autism in an Urban Clinic Using an Electronic M-CHAT
CHKD-affiliated author(s): Dr. John Harrington

This research evaluated the computerized version of the Modified Checklist for Autism in Toddlers (M-CHAT) that automatically uses the M-CHAT follow-up interview algorithms for positive screens. This computerized version drastically reduces false positive readings versus the paper M-CHAT that often misidentifies children who are not on the autism spectrum. This computerized M-CHAT could help improve autism screening in private practice by eliminating unnecessary referrals.

August 2012
International Journal of Pediatric Otorhinolaryngology, Volume 76, Issue 9
Quality of Internet information in pediatric otolaryngology: A comparison of three most referenced websites
CHKD-affiliated author(s): Dr. Craig Derkay, Dr. Cristina Baldassari

This research evaluated the accuracy of three Internet sites used most frequently to find out about medical conditions, Wikipedia, eMedicine and MedlinePlus. Twenty-four diagnoses in pediatric otolaryngology were entered in Google and articles were accessed for each topic in the three most frequently referenced sites. Both Wikipedia and MedLine plus had almost twice as many inaccuracies as eMedicine, although eMedicine rated as more challenging to read and navigate.

American Academy of Pediatrics News, Volumne 30, Issue 16
Sickle cell trait only one condition that can increase risk of sudden death during exercise
CHKD-affiliated author(s): Dr. Eric Werner

This article reviews the prevalence of athletes with Sickle cell trait who die suddenly during exercise and recommends both increased testing and education on exercise modification during sports practices, especially when it's hot and humid.

July 2012
Archives of Otolaryngology Head & Neck Surgery, Volume 138, Issue 7
Analysis of Pediatric Direct Laryngoscopy and Bronchoscopy Operative Flow: Opportunities for Improved Safety Outcomes
CHKD-affiliated author(s): Dr. Craig Derkay

This study examined minor problems that occur during a common examination of the throat called direct laryngoscopy. Although a common pediatric otolaryngology procedure, direct laryngoscopy and bronchoscopy operative flow is ideal in less than half the cases. Areas for improvement include obtaining intravenous access, reducing operating room personnel turnover, verifying equipment, and educating staff on operating room setup. To our knowledge, this is the first observational quality improvement initiative in otolaryngology to study the operative flow of a specific procedure and provide insight into areas of patient risk and opportunities for improvement in efficiency.

Infant, Child and Adolescent Nutrition, Volume 4, Number 5, October 2012 p.303-309
Pediatric Obesity and Nutrition Counseling
CHKD-affiliated author(s): Melanie J Wilhelm DNP, CPNP

About one third of children are overweight/obese. This study examined whether these children were more likely to have nutrition counseling documented, and if counseling was impacted by gender or ethnicity. 

A retrospective secondary data analysis was used to explore nutrition counseling for an insured pediatric population. A sample of 526 records met inclusion criteria. Member records were categorized based on Body Mass Index (BMI) as underweight, normal weight, or overweight/obese. 

The observed proportion of overweight/obese children was significantly higher than the national average, 37% versus 33% respectively, p = .03. No significant difference was found in documented nutrition counseling for children with overweight/obese BMIs, Pearson χ2 (1, N=526) = 1.586, p=.21, Φ = .06. Likewise, no significant difference was found in documented nutrition counseling for overweight/obese children by race, Pearson χ2 (1, N=37) = .11, p=.74, Φ = .05, or gender Pearson χ2 (1, N=194) = .35, p=.55, Φ = -.04. In this sample, African American children were almost twice as likely to have Medicaid compared to commercial benefits, Pearson χ2 (1, N=114) = 13.57, p 

The purpose of this study was to explore differences in documented nutritional counseling for an insured pediatric population. This study revealed a significantly higher proportion of overweight/obese children compared with the national average. 

Research Presented 
“Pediatric Obesity and Nutrition Counseling.” Poster presentation at the National Institute of Children’s Health Quality. Atlanta, GA, March 10, 2010. 

Sponsoring agency 
Optima Health Care, Norfolk, VA and Old Dominion University 

URL: Additional Information
June 2012
Pediatrics, Volume 129, Issue 6, June 2012
Randomized trial of sumatriptan and naproxen sodium combination in adolescent migraine
CHKD-affiliated author(s): Don Lewis

April 2012
Molecular Immunology
Potent inhibition of the classical pathway of complement by a novel C1q-binding peptide derived from the human astrovirus coat protein
CHKD-affiliated author(s): Dr. Kenji Cunnion, Neel Krishna, PhD

This research reported on the discovery by two CHKD-affiliated researchers of a compound that can stop a deadly immune response that strikes children and adults after they have suffered prolonged periods without oxygen.

Journal of Emergency Management
Evaluation of a Crisis Management Train the Trainer Program for School Personnel
CHKD-affiliated author(s): Korrie Allen, PsyD, Kelli Will, PhD, Dr. Michael Poirier

Molecular Immunology, Volume 50
Complement regulator C4BP binds to Staphylococcus aureus and decreases opsonization
CHKD-affiliated author(s): Dr. Kenji Cunnion

Pediatrics, Volume 129, Issue 5
Effective Analgesia Using Physical Interventions for Infant Immunizations
CHKD-affiliated author(s): John Harrington

This research showed that a parenting technique designed to calm agitated infants can be used to reducing crying and pain during infant immunization.

March 2012
Pediatrics 2012, Volume 160
Effects of Chronic Transfusions on Abdominal Sonographic Abnormalities in Children with Sickle Cell Anemia
CHKD-affiliated author(s): Dr. William Owen

January 2012
Journal of Pediatrics, online version
Crossed-Fused Testicular Ectopia: A Case for the Use of Laparoscopy to Evaluate Nonpalpable Testicles
CHKD-affiliated author(s): Dr. Jyoti Upadhyay

December 2011
Consultant for Pediatricians, December 2011
Obesity in Children and Adolescents: Identifying Eating Disorders
CHKD-affiliated author(s): Dr. Dominique Williams

November 2011
Pediatric Pulmonology, Volume 46, Issue 7
Impact of an evidence-based algorithm on quality care in pediatric parapneumonic effusion and empyema
CHKD-affiliated author(s): Dr. Kyrie Shomaker

September 2011
Newborn & Infant Nursing Reviews
Following the Diagnosis of Neonatal Hypoxic Ischemic Encephalopathy: A Family-centered Approach
CHKD-affiliated author(s): Katherine M. Newnam, NNP

This article covers the importance of communicating clearly with parents whose children are suffering catastrophic conditions as newborns, a chief goal of family-centered care.

Newborn & Infant Nursing Reviews
Neonatal Hypothermia:A Method to Provide Neuroprotection After Hypoxic Ischemic Encephalopathy
CHKD-affiliated author(s): Katherine M. Newnam, NNP; Donna L. DeLoach, NNP

This research covers the importance of nursing protocols used in the treatment of infants undergoing therapeutic hypothermia, or cooling therapy, that reduces death and severe brain damage in infant deprived of oxygen for prolonged periods of time, a therapy pioneered at CHKD.

August 2011
Journal of Pediatrics Volume 159, Issue 2
Increasing severity of pectus excavatum is associated with reduced pulmonary function
CHKD-affiliated author(s): Dr. Michael Goretsky, Dr. Robert Kelly, Dr. Donald Nuss

This study of 310 patients from 6 to 21years old found that patients with more severe cases of sunken chest or pectus excavatum have a higher likelihood of suffering decreased pulmonary function.

July 2011
Health Promotion Practice
Challenges and Opportunities for Promoting Booster Seat Use: Progressive Dissemination of a High-threat Message
CHKD-affiliated author(s): Kelli Will, PhD

This research examined the various methods to promote booster seat use, including disseminating information about the threat of injury to children who do not use booster seats.

June 2011
Studies In Health Technology And Informatics, Volume 163
A design for simulating and validating the Nuss procedure for the minimally invasive correction of pectus excavatum
CHKD-affiliated author(s): Dr. Michael Goretsky, Dr. Robert Kelly, Dr. Frazier Frantz

Performed in affiliation with Old Dominion University's Modeling and Simulation Program, this research proposes a strategy for developing a virtual training module for surgeons to practice performing the minimally invasive Nuss procedure to correct pectus excavatum, or sunken chest.

Journal of Pediatric Surgery, Volume 46, Issue 6
Regional chest wall motion dysfunction in patients with pectus excavatum demonstrated via optoelectronic plethysmography
CHKD-affiliated author(s): Dr. Michael Goretsky, Dr. Ann Kuhn, Dr. Robert Kelly, Dr. Donald Nuss

Motion-capture video techniques used in movies such as "Avatar" found that patients with uncorrected sunken chest, or pectus excavatum, have dysfunctional chest-wall motion that may explain reports of easy fatigability or shortness of breath.

Journal of Pediatric Surgery, Volume 46, Issue 6
One hundred patients with recurrent pectus excavatum repaired via the minimally invasive Nuss technique--effective in most regardless of initial operative approach
CHKD-affiliated author(s): Dr. Robert Kelly, Dr. Donald Nuss, Dr. Michael Goretsky, Dr. Ann Kuhn, Dr. Robert Obermeyer

The minimally invasive Nuss technique is safe and effective for the correction of recurrent PE. Patients with prior Nuss repair can have extensive pleural adhesions necessitating decortication during secondary repair. Patients with the traditional invasive correction may have acquired thoracic chondrodystrophy that may require a greater number of pectus bars to be placed at secondary repair and greater risk for complications. We have a greater than 95% success rate regardless of initial repair technique.

December 2010
Journal of Pediatrics, Volume 157, Number 6
Endocrine dysfunction following traumatic brain injury in children
CHKD-affiliated author(s): Dr. Kent Reifschneider

Annals of Surgery, Volume 252, Issue 6
Twenty-one Years of Experience with Minimally Invasive Repair of Pectus Excavatum by the Nuss Procedure in 1215 Patients
CHKD-affiliated author(s): Dr. Robert Kelly, Dr. Michael Goretsky, Dr. Robert Obermeyer, Dr. Ann Kuhn, Dr. Richard Redlinger, Dr. Donald Nuss

Surgeons at CHKD have performed the minimally invasive Nuss procedure to correct pectus excavatum, or sunken chest, on 1,215 patients since 1987, when the technique was pioneered by surgeon Donald Nuss. In a review of those cases, 95.8% reported good to excellent anatomic results. This article also reports on refinements developed over the last two decades that have increased the minimally invasive surgery's safety and success.

November 2010
Clinical Genetics, Volume 78, Issue 5
Variable Number of Tandem Repeat Polymorphisms (VNTR’s) in the ACAN Gene Associated with Pectus Excavatum
CHKD-affiliated author(s): Michael Stacey, PhD, Dr. Robert Kelly, Dr. Ann Kuhn, Dr. Michael Goretsky, Dr. Virginia Proud

In an ongoing effort to determine a genetic cause of pectus excavatum, researchers looked for defects in a gene that helps build the cellular scaffolding of human cartilage. Although no correlation was found between the gene and pectus excavatum using the technique the researchers employed, researchers are continuing to look for a genetic causes of pectus excavatum, which often runs in families.

Pediatrics, Volume 126, Number 5
The Actual Prevalence of Autism: Are We There Yet?
CHKD-affiliated author(s): Dr. John Harrington

August 2010
Virginia Pediatrics, Summer 2010
A Childhood Problem Grows Up: Caring for Adults with Congenital Heart Disease in Virginia
CHKD-affiliated author(s): Dr. Alexander Ellis

This article deals with a problem created by the success of pediatric cardiologists and pediatric cardiac surgeons keeping their patients alive longer -- today, there are adults suffering congenital conditions that years before would have been fatal. Implications for continued treatment are discussed.

Virginia Pediatrics, Summer 2010
Health Care Reform for Virginia’s Children
CHKD-affiliated author(s): Dr. Bryan Fine

Virginia Pediatrics, Summer 2010
Late Effect Clinic: Endocrinological Follow-up for Childhood Cancer Survivors
CHKD-affiliated author(s): Dr. Kent Reifschneider

Virginia Pediatrics, Summer 2010
Prenatal and Postpartum Depression in Fathers: Brief Report of a Meta-Analysis
CHKD-affiliated author(s): James Paulson, PhD

While a lot of research has been conducted on postpartum depression in new mothers, this study found that postpartum depression occurs in fathers as well and discusses is implication for the family and the child.

Virginia Pediatrics, Summer 2010
Insulin Pumps in Small Children
CHKD-affiliated author(s): Dr. Eric Gyuricsko

Virginia Pediatrics, Summer 2010
Is It Reflux or Something Else? A Primer on Eosinophilic Esophagitis for the Pediatrician
CHKD-affiliated author(s): Dr. Lauren Willis, Dr. Kelly Maples

This research presents ways to diagnosis a rare chronic condition, eosinophilic esophagitis, which is often misdiagnosed and can cause permanent scarring in the esophagus without early identification and proper treatment.

July 2010
Consultant for Pediatricians, July 2010
What’s Your Diagnosis?
CHKD-affiliated author(s): Dr. John Harrington

Pediatric Annals, Volume 39, Issue 7
Headache Evaluation in Children and Adolescents: When to Worry? When to Scan?
CHKD-affiliated author(s): Dr. Donald Lewis

June 2010
Seminars in Pediatric Neurology, Volume 17, Number 2
Secondary Headaches in Children and Adolescents
CHKD-affiliated author(s): Dr. Donald Lewis

April 2010
Virginia Pediatrics, Spring 2010
Reporting on the Third National Conference of State/Territory/Tribal Breastfeeding Coalitions
CHKD-affiliated author(s): Dr. Natasha Sriraman

March 2010
Pediatric Dermatology, Volume 27, Issue 2
Sweet Syndrome in Infancy
CHKD-affiliated author(s): Dr. Kenji Cunnion, Dr. Randall Fisher, Dr. Judith Williams

February 2010
Consultant for Pediatricians, Volume 9, Issue 2
Autism Spectrum Disorders: What to make of the latest statistics
CHKD-affiliated author(s): Dr. John Harrington

January 2010
Journal of Pediatric Surgery, Volume 45, Issue 1
Minimally Invasive Repair of Pectus Excavatum in Patients with Marfan Syndrome and Marfanoid Features
CHKD-affiliated author(s): Dr. Richard Redlinger, Dr. Gregory Rushing, Dr. Robert Kelly, Dr. Robert Obermeyer, Dr. Michael Goretsky

The presence of a pectus excavatum requiring surgical repair is a major skeletal feature of Marfan syndrome, a rare disorder of connective tissue that strengthens the body's structures. This research reviewed surgical records of patients with Marfan syndrome or Marfanioid features and determined that such patients tend to have more severe pectus excavatum requiring multiple bars for chest repair. The review also documents that the minimally invasive procedure is safe and effective despite the severity of the defect.

Consultant for Pediatricians, Volume 9, Issue 1
Morning Report: Infant with persistent noisy breathing
CHKD-affiliated author(s): Dr. John Harrington

November 2009
Medical Mycology, Volume 47
In vitro pharmacologic characteristics of griseofulvin against dermatophyte isolates of Trichophyton tonsurans from tinea capitis patients
CHKD-affiliated author(s): Dr. Judith Williams

October 2009
Journal of Applied Physiology, Volume 106
Repeated-bout exercise in the heat in young athletes: physiological strain and perceptual responses
CHKD-affiliated author(s): Dr. Joel Brenner

September 2009
Critical Care Medicine
Clinical Practice Parameters for Hemodynamic Support of Pediatric and Neonatal Septic Shock: 2007 update from the American College of Critical Care Medicine
CHKD-affiliated author(s): Dr. Arno Zaritsky

August 2009
Consultant for Pediatricians, Volume 8, Issue 8
What's Your Diagnosis? Osteochondroma
CHKD-affiliated author(s): Dr. John Harrington

July 2009
Accident Analysis and Prevention, Volume 41
Evaluation of The Boost ‘em in the Back Seat Program: Using fear and efficacy to increase booster seat use
CHKD-affiliated author(s): Kelli Will, PhD

This research found that using fear of injury was an effective way to increase the use of booster seats.

April 2009
Consultant for Pediatricians, Volume 7, Issue 2
Photoclinic: Inflammatory Linear Verrucous Epidermal Nevus or ILVEN
CHKD-affiliated author(s): Dr. John Harrington

March 2009
Archives of Dermatology
Prevalence of Adrenal Insufficiency Following Systemic Glucocorticoid Therapy in Infants With Hemangiomas
CHKD-affiliated author(s): Dr. Kent Reifschneider

February 2009
Pediatrics, Volume 123, Number 2
Randomized, Double-Blind, Placebo-Controlled Study to Evaluate the Efficacy and Safety of Topiramate for Migraine Prevention in Pediatric Subjects 12 to 17 Years of Age
CHKD-affiliated author(s): Dr. Donald Lewis

This study evaluated the effectiveness of one of the few drugs, topiramate, that has been found to be effective at stopping migraine headaches in adolescents.

Journal of the American Academy of Dermatology, Volume 60, Issue 2
Congenital herpes simplex virus infection: two unique cutaneous presentations associated with probable intrauterine transmission
CHKD-affiliated author(s): Dr. Judith Williams, Dr. Thomas Bass, Dr. Randall Fisher

Journal of Allergy and Clinical Immunology, Volume 123, Number 2
Resolution of Submucosal Fibrosis in a Case of Fluticasone-Resistant Eosinophilic Esophagitis
CHKD-affiliated author(s): Dr. Lauren Willis, Dr. Kelly Maples

December 2008
Pediatrics, Volume 22, Issue 6
The Surgical Repair of Pectus Excavatum Markedly Improves Body Image and Perceived Ability for Physical Activity; Multicenter Study
CHKD-affiliated author(s): Dr. Donald Nuss, Dr. Robert Kelly, Dr. Michael Goretsky, Karen Mitchell, RN

Patients who have had pectus excavatum correct often report an improved body image and ability to exercise, including some who have excelled in competitive sports. While those cases are anecdotal, this study documented the improved body image and decreased problems exercising with research conducted at 11 North American hospitals.

October 2008
Archives of Dermatology, Volume 144, Issue 10
Pock-like scarring and sublingual papules in a child: Lipoid Proteinosis
CHKD-affiliated author(s): Dr. Judith Williams

September 2008
Advances in Pediatrics, Volume 55, Issue 1
Minimally Invasive Surgical Correction of Chest Wall Deformities in Children
CHKD-affiliated author(s): Dr. Donald Nuss, Dr. Robert Kelly

This study discusses the entire pectus surgery process including evaluation, surgical correction and long-term outcomes.

August 2008
Seminars in Pediatric Surgery, Volume 17, Issue 3
Chest Wall Deformities
CHKD-affiliated author(s): Dr. Donald Nuss, Dr. Robert Kelly

In recognition of their critical roles in developing cutting-edge treatment of chest wall deformities such as pectus carinatum and pectus excavatum, the journal Seminars in Pediatric Surgery tapped CHKD surgeons Dr. Donald Nuss and Dr. Robert Kelly to edit an August 2008 issue focusing on surgery to correct the anomalies. Nuss and Kelly recruited surgeons to author the articles and edited the entire journal.

Current Opinion in Pediatrics, Volume 20, Issue 4
Human Papillomavirus (HPV) Vaccine: Recommendations, Issues and Controversies
CHKD-affiliated author(s): Dr. Randall Fisher, Dr. David Darrow, Dr. Judith Williams

July 2008
Consultant for Pediatrians, Volume 7, Issue 11
Consultation and Comments: Vaccines, the Public Trust, and the Importance of the Medical Home
CHKD-affiliated author(s): Dr. John Harrington

Pediatric Clinics of North America, Volume 55
Outcome Following Cardiopulmonary Arrest
CHKD-affiliated author(s): Dr. Arno Zaritsky

February 2008
Journal of the American Academy of Dermatology, Volume 58
Necrolytic migratory erythema-like presentation for cystic fibrosis
CHKD-affiliated author(s): Dr. Donald Lewis, Dr. Judith Williams

September 2007
Contemporary Surgery, Volume 63, Issue 9
Our approach: MIS repair of pectus excavatum
CHKD-affiliated author(s): Dr. Donald Nuss, Dr. Ann Kuhn, Dr. Robert Obermeyer

The minimally invasive approach to pectus excavatum repair has become widely accepted by pediatric surgeons, thanks to good long-term outcomes. These include recent refinements of the technique, including routine use of thoracoscopy and stabilizers, rib securing sutures and new instruments, that have eased the insertion and stabilization of the substernal support bar.

August 2007
Journal of American College of Surgeons: Volume 205, Issue 2
Prospective Multicenter Study of Surgical Correction of Pectus Excavatum: Design, Perioperative Complications, Pain, and Baseline Pulmonary Function Facilitated by Internet-Based Data Collection
CHKD-affiliated author(s): Dr. Donald Nuss, Dr. Robert Kelly, Dr. Michael Goretsky, Traci Bagley, RN

Researchers examined and compared the results of 327 post-surgical pectus excavatum patients whose surgery was performed at 11 centers in North America. Of those patients, 284 underwent the minimally invasive Nuss procedure and 43 had the open surgery that was the previous standard of care. While the small number who had the older procedure made meaningful comparisons between the two groups impossible, the case review confirmed that pectus patients overall showed depressed lung function before the surgery and that the surgical techniques developed by Nuss were safe and effective.

October 2006
The Japanese Journal of Thoracic and Cardiovascular Surgery
Family study of the inheritance of pectus excavatum
CHKD-affiliated author(s): Dr. Donald Nuss, Dr. Robert Kelly, Dr. Michael Goretsky, Dr. Virginia Proud and Karen Mitchell, RN

CHKD clinicians reviewed 34 cases of pectus excavatum and confirmed anecdotal observations that many cases appear to have a genetic basis. They also observed other disorders – and Ehlers Danlos syndrome – that often occur along with pectus excavatum, as well as benign physical traits such as long arms and legs and high-arched palates.

September 2006
Journal of Pediatric Surgery: Volume 41, Issue 9
Classification of the dysmorphology of pectus excavatum
CHKD-affiliated author(s): Dr. Donald Nuss, Dr. Robert Kelly, Dr. Michael Goretsky, Dr. Virginia Proud, Karen Mitchell, RN

CHKD researchers, surgeons and nurses examined the case files and clinical findings in 64 pectus patients to gather epidemiological information such as the incidence in males and females, the age the problem presented itself and the different forms of the condition, including the length, shape and the location of the depressed portion of the chest.