June 21, 2019
At Pediatric Grand Rounds last October, Tina Cheng, co-director of Johns Hopkins Children’s Center, introduced Akhil Maheshwari, the hospital’s new director of neonatal medicine. “We’re very excited about being able to recruit him here,” she said, noting that Maheshwari increased the patient census in the neonatal intensive care unit (NICU) at his previous hospital by 30 percent. “He’s an incredible program builder, mentor and leader.”
After Cheng’s introduction, Maheshwari moved on to his Grand Rounds presentation on the pathology of necrotizing enterocolitis (NEC), his major focus as a physician scientist. Only later would he note his excitement about coming to Baltimore. Why? In the past, he said, institutions sought him. “This,” he said, “is the one job I actually sought.”
Johns Hopkins, he explained, is known for its collaborative culture and clarity of mission—the development of groundbreaking treatments. He pointed to renowned experts in neonatology and pediatrics at Johns Hopkins Children’s Center.
“Almost everything I do in research is based on concepts that emerged from this place, including the strides in pediatric hematology, inflammation and neonatal intestinal injury,” says Maheshwari. “It was the academic intensity and density of investigators that brought me here.” His path to Johns Hopkins began in a suburb of Delhi, India, where Maheshwari grew up with three siblings, his mother—a homemaker—and his father, a university physics professor. As a child, the physicians he saw in the community, and their focus on continuity of care, left an impression and spurred an interest in medicine. He knew that medical school admission in India was extremely competitive, with only 35 students accepted each year out of some 165,000 applicants. He was one of them.
“I was fortunate enough to get into one of the top schools,” he says. “The good news is you literally have a free ride once you get in.”
Going through his clinical rotations, he immediately connected with pediatrics, where most patients got better. “With children,” he says, “the beauty was there was a greater possibility of a cure.”
He was hooked. Maheshwari pursued a newborn residency and fellowship in India after learning that neonates with very complex conditions could be cured. The programs did not offer a research track, however, which shifted his eyes to the United States and Robert Christensen, a world leader in neonatal hematology at the University of Florida. Maheshwari found his mentor and a physician scientist track, which led to his first faculty appointment at the University of Alabama, where he established his own lab and a challenging future direction: “Increasingly I felt we had a progressively better handle on lung disease of prematurity, but the loss of infants due to intestinal injury was something that struck me.”
From there he went to the University of Illinois at Chicago, where he rebuilt and grew the neonatology program and its fellowship by a third. “That is where I learned about program building,” says Maheshwari.
Generous benefactors lured him south again to a new NICU at the University of South Florida. There he kick-started neonatal research efforts and a dual track for neonatologists who wanted to train in another specialty.
His accumulated experience and growing expertise groomed Maheshwari for the neonatal and perinatal medicine leadership position at Johns Hopkins. Here, in collaboration with division faculty, he crafted a blueprint focusing on five areas of improvement: data science, genomics, imaging, immune programming and maternal-fetal medicine.
Advances in these areas, Maheshwari stresses, will require large data searches and collaboration among immunologists, microbiologists, computational biologists, radiologists and others, all of whom, he notes, Johns Hopkins has a deep bench. The development of new genomic tools and techniques—and education and training to use them—is especially important, Maheshwari says. Neonatologists must also keep a constant eye on the horizon, he adds, to track patients’ changing needs.
“It is very likely that how we treat patients and think about their disease conditions and meet their needs will change in the next 10 years,” says Maheshwari. “I believe we will have access to more diagnostic information, which will allow treatment to become less intrusive, perhaps more tailored and more effective. That is the high-energy barrier we need to cross.”
