In a wide-ranging interview conducted at the 2023 Pediatric Academic Societies Meeting, we talk with Juan Salazar, MD, MPH, FAAP, Physician-in-Chief of Connecticut Children’s, about the growing need for collaborative pediatric research, tackling health disparities in a multicultural capital city, and what it was like to be an infectious disease specialist leading a pediatric health care system through a pandemic.
Carol Vassar, producer
Guest: Juan C. Salazar, MD, MPH, FAAP
Physician-in-Chief and Executive Vice President of Academic Affairs
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Carol Vassar, podcast host/producer (00:00):
Welcome to Well Beyond Medicine, the Nemours Children’s Health Podcast. Each week we’ll explore anything and everything related to the 80% of child health impacts that occur outside the doctor’s office. I’m your host, Carol Vassar. And now that you’re here, let’s go.
Let’s go! Well Beyond Medicine.
Carol Vassar, podcast host/producer (00:27):
One of the great aspects of taking a podcast on the road to events like the 2023 Pediatric Academic Society’s meeting is that you never know who you’ll run into and who might accept a spur-of-the-moment invitation to sit down with us for a podcast interview. It was a chance conversation with a Connecticut Children’s representative who brought her chief medical officer to our podcast studio. His name is Dr. Juan Salazar. First, though, a bit about Connecticut Children’s. It is a storied pediatric healthcare provider, established in 1898 in the small farming community of Newington, just south of Connecticut’s capital, Hartford, by the Connecticut Children’s Aid Society. In the 20th century, as Newington Children’s Hospital, its growth with an emphasis on orthopedics, followed by a rapid expansion in specialties services, affiliations, and locations paralleled that of a not-so-far-away neighboring hospital, Nemours Children’s Hospital, Delaware.
Today, both hospitals are anchors of growing pediatric healthcare systems. In a wide-ranging interview, Dr. Salazar and I talk about some of those parallels and differences, the growing need for collaborative pediatric research, tackling healthcare disparities in a multicultural capital city, and what it’s like to be an infectious disease specialist leading a pediatric healthcare system during a pandemic. We started our conversation, though by remembering a significant move that occurred in 1996. That’s when Newington Children’s Hospital left that small town and made its way to a new medical center. By the way, Dr. Salazar refers to University Hospital during our conversation, which is affiliated with the University of Connecticut. Here’s Dr. Juan Salazar.
Juan Salazar, MD, Connecticut Children’s (02:22):
It was one location in Hartford, and everything was there. That’s when x-rays were x-rays and medical records were paper records, and we had all in one building. We now have grown to 43 different locations. We’re beyond Connecticut, up into Massachusetts and New York State. So we actually have expanded and our catchment area has now increased to 1.2 million kids across that area. So we’re no longer a medical center. We are now a health system. So Connecticut Children’s is the new way; that’s our new designation. We still have the medical center in Hartford, which is the main hub, the main hospital. And initially, Connecticut Children’s was meant to be a children’s hospital for Hartford County, primarily to provide pediatric services. And there was a unification of three different systems, which I can talk about in a minute now. It’s become a health system for kids across the northeast, and we’re growing.
So it’s no longer only a clinical facility. We have to provide many, many more services. One of them, which is really important for children’s health systems, is research and innovation, new cures, new treatments, new ways of thinking about social determinants of health, of how we take care of kids, and the best way of taking care of them. So three years ago we put together all our research infrastructure and we founded what is called the Connecticut Children’s Research Institute, CCRI. And we’re very proud that that’s growing. It’s getting bigger; we’re getting more NIH funding, we’re increasing our catchment area for research as well. Not only locally but also internationally. So we’re very excited about the research that’s going on at Connecticut Children’s right now.
Carol Vassar, podcast host/producer (04:02):
Talk about the importance of research in pediatrics to not only the children of Connecticut but children writ large.
Juan Salazar, MD, Connecticut Children’s (04:10):
Critical, absolutely critical. We cannot be, and you cannot be, a top children’s hospital without being top in research. Kids are changing all the time. Diseases are changing all the time. What we see today in terms of clinical care, inclusive diagnosis, very different than what we saw 15, 20, 30 years ago. So we have to adapt. We have to bring new ways of providing the care for the kids. And that can only be done through research in your community and beyond your community. So for children’s hospitals, for you to be able to attract top talent, for you to be able to attract patients from across the world, across the nation, research has to be part of it. Obviously well done, well regulated with proper checks and balances so that you actually can do things correctly. But without research, a children’s health system simply is missing one of its arms. And this is why every children’s health system has to do research, absolutely critical.
Carol Vassar, podcast host/producer (05:03):
Connecticut Children’s is an outgrowth of what was once known as Newington Children’s Hospital. I’m a Newington girl, and we were well aware when the hospital moved to Hartford and became Connecticut Children’s ultimately. Can you talk to the history, speak to the history? Which is actually very similar to Nemours’ history of the Newington Children’s Hospital.
Juan Salazar, MD, Connecticut Children’s (05:24):
Yeah. So I’ll tell you a story because I have been at Connecticut Children’s now for 25 years, but I was there before also as a pediatric resident from 1988 through 1991. And I was chief resident for a year from ’91 to ’92. It didn’t exist back then. So I’ll tell you a story, which is a real story. And my wife is also a pediatrician, a pediatric cardiologist at the Children’s Hospital. She’s here also. I was a second-year resident; my wife was a first-year intern. We were on call together at the university hospital in Farmington. That’s where the oncology kids would be taken care of. We did not have an intensive care unit. The intensive care unit was our Hartford Hospital. And we were taking care of a 12-year-old who had been diagnosed with leukemia with a very high white blood count and had been put on chemotherapy.
And kids from chemotherapy developed something called tumor lysis, which, as you give the chemotherapy, the cells break down, and all the products are released, and the release of those products can sometimes cause something that is a shock-like syndrome, which is really life-threatening. So here I am, second-year resident, first-year resident together on call. And at around midnight, this kid basically went into shock, blood pressure dropped. So we got to work as I always have done with my wife; we’ve worked closely throughout our careers and very busy with this patient. But we did not have an intensive care unit at the University Hospital for children. The intensive care unit was at Hartford Hospital. We stabilized the kid, obviously, with some additional support. The next morning I had to call an ambulance and actually transport that child from the University Hospital to Hartford Hospital for ICU care for the next five, 10 days.
That kid eventually recovered, but guess what? It needed rehabilitation. And where would that be done? That was at Newington Children’s. So here’s a family that had to go from Farmington, Connecticut, to Hartford to Newington. This is the way it used to be. That didn’t make sense. So the University of Connecticut School of Medicine, Hartford Hospital and Newington Children’s Hospital, which was a freestanding children’s hospital there many years in negotiation, came together and they said, “This doesn’t make sense for our community. We’ve got to come together.” So we were very lucky because we had Newington Children’s. Beautiful, absolutely remarkable facility. And a little bit of history, which you probably know, but it initially, back in the 1800s, it was called the Hospital for the Incurables. Imagine bringing your kid to the Hospital for the Incurables in the late 1800s.
Then it transitioned, they changed the name and it was the Hospital for Crippled Children. And this was primarily due to the poliomyelitis epidemic. And so many kids were in that hospital for polio. And it became an incredible hospital for polio care in the ’20s and ’30s. In fact, President Roosevelt visited the facility after he was diagnosed with poliomyelitis. Eventually, it changed the name to Newington Children’s Hospital, which is a great community in Connecticut. But all these three locations came together. And in 1998, we founded what today is called Connecticut Children’s. We did not think that it was going to be as successful as it is right now. And again, it was built primarily a hospital for Hartford County. But guess what? It’s become a children’s hospital for all of Connecticut, parts of Massachusetts, and even parts of New York, which is really great. And now we’ve gone international as well.
Carol Vassar, podcast host/producer (08:40):
The growth is tremendous, and we’re tremendously proud of it. Let’s talk about the new tower.
Juan Salazar, MD, Connecticut Children’s(08:46):
Carol Vassar, podcast host/producer (08:47):
I had the unfortunate experience of spending some time in Hartford Hospital recently for some personal reasons. And the tower was starting to go up. And this is a new tower for Connecticut Children’s. Talk about that.
Juan Salazar, MD, Connecticut Children’s (09:02):
Yeah, it’s very exciting. We have 187 beds, it’s a small children’s hospital, but at 187 beds compared to the larger ones, we’re out of space. We simply can no longer provide the care that we needed in our space because it’s been so successful that people are coming all the time to Connecticut Children’s. So we don’t have enough space. So we have to grow. We actually broke ground on Friday, which is very exciting. Superhero days, we actually could do it with both things. And this new tower, which is going to open in November of 2025, will have 15 new NICU beds, individual rooms, 300 square feet each one of them, where the mother can stay there. They’ll have individual bathrooms so the mother or the father can stay with the baby at all times. Which that’s the way it should be, frankly.
And so we can regulate the noise, regulate the temperature, regulate the lighting so it mimics for that little baby, the 24, 25 weeker, what would happen in utero. It’s a much safer environment for them. So we’re actually moving in that direction. That’s the first thing, 15 NICU beds. Six fetal center beds. We will be one of the only six programs in the nation with a fetal center. Dr. Tim Crombleholme, who’s a fetal surgeon and world-renowned fetal surgeon, has already joined us. He’s in Connecticut now. And we will have six beds that will have the mother and the infant and two large operating rooms in the middle where we can actually do in-utero surgery to correct some of the defects that need to be done. And again, only six of these locations in the entire country. We will be one of them.
We’ll be the only one that in New England that actually has that capacity. And, in fact, the only, the closest one is Cincinnati and the other one will be in Children’s Hospital of Philadelphia. Next thing we’ll have is additional ICU beds. This past October, with the R RSV pandemic that we had, or I call it a pandemic, all though it was tridemic, whatever you want to call it. But we were out of beds. We were in the national news media because we said we were going to put a tent in front of the hospital.
We didn’t have to do that, but it was very close. It was so busy, and we did not have enough hospital beds or ICU beds, and we had to change the dynamics. So we’re adding 14 acuity adaptable beds, which will be both ICU and regular medical care. And that’s something else we’re adding. And the next thing is we’re putting six bone marrow transplant beds. Right now, we have to send kids out. We send them to Dana-Farber or Sloan Kettering for the bone marrow transplant. We won’t have to do that anymore in two, three years. What you can see is that we have been successful, we are growing, we’re expanding. And this new tower is going to change the face for Hartford, frankly.
Carol Vassar, podcast host/producer (11:34):
And if I’m not mistaken, you are an infectious disease specialist. Talk about your pandemic experience, if you would.
Juan Salazar, MD, Connecticut Children’s (11:41):
Yeah, I mean, everyone probably will be able to tell stories for many, many years. As physician-in-chief, I was lucky that I had training in infectious disease. It just happened to be that I was the physician-in-chief of Connecticut Children’s, and I had training in this specific area. So very quickly, we had to adapt. I remember three years ago, looking at March of 2020, when this whole thing hit us with a way that we never thought, and it was very difficult, scary, daunting. But our team came together, as all the children’s hospitals did. I’m sure Nemours did exactly the same thing. And what I saw was the resilience of people, the care of people, the commitment to kids, which led us to going to the hospital every day and take care of the kids and make sure that we had everything in place.
We had three main objectives. One, make sure we could provide care for the kids that were coming in with COVID. And fortunately, we didn’t have many, which that was good news. The second thing is that we had the ability to provide safety to our staff so that our nurses and doctors would not get sick. And so, how do we do that? And the third thing is how do we prepare even to move forward into the next phase of the pandemic once we came out of it, including financially? The children’s hospitals were hit pretty hard because we actually had to close our wards; we had to close our clinics for the safety. So we created task forces for each one of those areas, and we moved very quickly, effectively, everyone came together, and we delivered. And at the end of the day, we made it through.
And today, as you look back and you think, you say, “Wow, how did that happen?” But fortunately, we came out really strong as a health system. Actually, we’re stronger now than before the pandemic to the point that we are just at the tail end of the pandemic; we can actually build an almost 320 million facility. And that tells the world that Connecticut Children’s and the people there and the care and the support of the people of Connecticut, that what they have given us is remarkable. And I think that’s true of all the children’s hospitals, which is really nice.
Carol Vassar, podcast host/producer (13:39):
When you look at the city of Hartford specifically, I know you’re a regional center these days, a regional healthcare system. But when you look at the city of Hartford, you have a great diversity of people. You have some very rich people in greater Hartford. You have some very poor people in both greater Hartford and Hartford itself. Let’s talk a little bit about health equity and how Connecticut Children’s is addressing health equity moving forward.
Juan Salazar, MD, Connecticut Children’s (14:04):
That’s a great question. And so one of the things we have to be careful in any system that’s doing tertiary/quaternary care like we’re doing now, like you guys are doing as well, is that you can’t limit your view to what happens inside the hospital because that’s really the tail end of a disease process when they’re coming in. But what’s really, really important is to look at your community. So the way we think about it is inside out, so that you’re really looking at the outside. So one of the things that we have real strength in is something called the Office for Community Child Health, OCCH, which is one of our pillars within Connecticut Children’s and is led by my mentor, former chair of the department, Dr. Paul Dworkin, who was chair of the department for 15 years. He was my mentor when I was the chief resident at the university, and then I followed him for ten years.
But Paul did not retire and go travel the world, still does some of that. But what he did is he said, “The next phase of my life, I’m going to do something that’s going to be impactful for this community.” And so he created the Office of Community Child Health. And what it does is it really brings Connecticut out into the community, and not just the local community, but really the national community. There’s a program that he founded that is called Help Me Grow, which is a national program. I think there are 32 states now that actually have implemented Help Me Grow. But to give you a specific example of how we take care of our community, unfortunately, Hartford is one of the poorest cities in the nation. Three towns across, we have some of the wealthiest cities or towns in the nation, but the city is not.
And so we have a responsibility for them. So Dr. Dworkin, in conjunction with the City of Hartford, the schools of Hartford, recently got an award from the Department of Education, a 30 million award for the north end of Hartford with a focus on the north end. And what they’re trying to do is use education, the schools, the preschools, begin to address social determinants of health in the community and to take those kids from the beginning, the time of delivery, all the way to the time to go to school and actually graduate and go to high school. So Connecticut Children’s is acutely aware of the importance of providing primary care, education, resources, prevention, partnering with the community so we actually can provide better care for those kids.
Carol Vassar, podcast host/producer (16:20):
I want to circle back to the research we’re doing and tie that into health equity. How are the principles of health equity informing the research that your research institute is doing? I’m happy
Juan Salazar, MD, Connecticut Children’s (16:31):
So we have nine different areas that are the centerpiece of the research institute. These are thematic areas. We can’t do everything. We’ve got to focus. And of course, there are many that are more basic science, translational science, but there’s one which it’s community-based. That’s specifically for the community. And I’ll give you an example. Asthma sadly, this is why I think one of the effects of the pandemic. This past year in Connecticut, we had two kids, teenagers, that died as a result of asthma. They died as a result of asthma. It’s crazy to think about that. And why is that? Well, when you start looking at what triggers lack of care, lack of access to medication, it’s the social determinants of health. And these kids are not just from the city of Hartford. There were kids from actual rural communities. Connecticut has these very poor rural areas as well.
So research and the research we do with a program called Easy Breathing, how do we implement Easy Breathing in the community, how do we help our pediatricians, how do we measure the outcome is really, really important. So anything in research has to be measured, quantitative, and then the results need to be looked at very critically to see if your intervention actually works. Community is prime for that. You can actually do things, things that actually change the outcome for those kids. Asthma is one of them. So we’re going to be paying very close attention. Why is it that a well-established, quantitative program like Easy Breathing is not functioning? Why is it not being implemented by the pediatricians? So we have to measure that. And then through research show that you have to pay for this, that the investment you actually put into training the pediatricians, which may cost a dime, is going to save you a million dollars. But not only that, it’s going to save you a life.
And so this is how we approach it, and any component of research that we do, we have to look at exactly how it’s affecting the community. My own research is in two areas. We’re focusing on developing a vaccine for syphilis. And syphilis is a tremendous problem that is affecting people all over the world but affects babies in a major way. We’ve had the largest number of cases of congenital syphilis in Connecticut in the past 15, 20 years. That’s true across the nation. State of Texas, last year, 600 cases of congenital syphilis and kids died as a result of congenital syphilis. When you look at the reasons why social determinants of health are right there, there’s no reason that a mom should not get prenatal care. There’s no reason that a mom should not actually get treated for syphilis with a very effective penicillin shot. But because it hasn’t worked, we need something that’s going to hopefully be implemented.
It’s going to take some time, but we’re developing a syphilis vaccine. And so my laboratory, along with Dr. Justin Radolf, who’s my colleague, and other people, obviously. We’re working very closely with them to try to develop a vaccine that could be used internationally in some way that would be critical. My other research is on COVID in MIS-C (Multisystem Inflammatory Syndrome in Children). We’re developing a professional point-of-care test when kids come into the emergency department. How can you diagnose them diagnose them quickly and easily? It’s hard to do. Some of these kids come in with multiple diseases that you have to think, and the pediatrician doesn’t really know what’s going on. So I can spend another half hour telling you about my research, but in the interest of time, I’m going to stop there.
Carol Vassar, podcast host/producer (19:48):
Let me ask you this real quick. Connecticut Children’s, you’re at this point; where will you be in 10 years, 20 years?
Juan Salazar, MD, Connecticut Children’s (19:56):
When I started 25 years ago, I don’t think I could have predicted that we would be in three different states. That we would have a catchment area of 1.2 million kids. The future is now, and this tower, the people that we’re recruiting into Connecticut, the innovation that’s been brought into Connecticut, I think, will make us one of the premier children’s hospitals in the country. We won’t be able to do it alone. I think this is something that more this is understood, and you’re using it as a conglomerate of children’s hospitals across the country that come with protocols, mission-driven, and you do it in a way that’s logical across the nation. So we’re growing, and what I foresee is that in 10 years, we’ll be partnering with systems like Nemours, and we’ll create larger systems that we’ll be able to have greater impact on the way we work. And hopefully, we can make life easier for these kids in the United States. There’s too much suffering right now. We got to change that.
Carol Vassar, podcast host/producer (20:54):
Thanks for listening to our conversation with Dr. Juan Salazar, Chief Medical Officer of Connecticut Children’s based in Hartford, Connecticut. What do you think about the rapid growth of pediatric healthcare systems throughout the nation? Leave a voicemail at nemourswellbeyond.org. That’s nemourswellbeyond.org. We’d love to hear your thoughts and maybe air them on an upcoming episode of the Well Beyond Medicine Podcast. While you’re there, check out our other episodes, subscribe to the podcast, and leave a review. I’m Carol Vassar, and I want to thank Che Parker, Cheryl Munn, and Susan Masucci for this week’s production assistance. Join us next week as we take a look at a program aimed at increasing the diversity of the academic pediatric workforce, the new Century Scholars Resident Mentoring Program. Until then, remember, together, we can change children’s health for good, Well Beyond Medicine.
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