Research and clinical work go hand in hand at the Division of Neonatology, which is part of UBMD Pediatrics at Oishei Children's Hospital. The advances made through research in the Division bring about direct improvements in the care of the hospital’s youngest, and perhaps most vulnerable patients.
The focus of the Division’s research is three-fold: to study how best to deliver critical care to babies with respiratory depression at birth and reduce oxygen toxicity; to discover the optimum management of newborns with persistent pulmonary hypertension (PPHN); and to further the treatment of necrotizing enterocolitis (NEC), a gastrointestinal disease that disproportionately affects pre-term infants.
Facilitating a Child’s Best Start in Life
To date, physicians from the Division in Buffalo, (Drs. Kumar, Mathew, and Lakshminrusimha) have received four grants from the American Academy of Pediatrics to study neonatal resuscitation.
An asphyxiated infant enters this world limp, apneic, and cyanotic, and requires immediate resuscitation. Yet the effects of resuscitation with varying levels of oxygen on pulmonary hemodynamics at birth are not well known. It is understood, however, that hyperoxic ventilation can cause oxidant injury and contribute to the worsening of pulmonary hypertension in newborns.
At present, investigators at the Division are conducting research focused on neonatal resuscitation and finding the optimum oxygen concentration to be used during resuscitation. These studies are far from theoretical, as timely and appropriate resuscitation at birth can mean the difference between death, survival with neurologic impairment, and in fact, survival.
Finding better ways to manage PPHN
During fetal life the lungs are not required for gas exchange, so pulmonary blood flow is low and pulmonary vascular resistance (PVR) is high. When the fetus adjusts to its new world at birth, its pulmonary circulation undergoes a striking transition, characterized by an 8- to 10-fold rise in pulmonary blood flow and a similarly significant decrease in PVR. When this transition does not occur spontaneously, the result can be persistent pulmonary hypertension of the newborn (PPHN), a condition associated with significant morbidity and mortality.
Traditional treatment for intractable PPHN that does not respond to mechanical ventilation and inhaled nitric oxide is Extra Corporeal Membrane Oxygenation, or ECMO, in which an oxygenator acts as an artificial heart and lungs. While it is a life-saving technique, ECMO is also highly invasive.
Currently under evaluation by the Division is the role of anti-oxidants and antenatal/postnatal steroids on fetal lung fluid, pulmonary hemodynamics and surfactant release. Another alternative treatment being studied that shows early promise is that of Sildenafil. The Division is presently involved in a five-center trial, the end goal of which is to evaluate the use of this medication in the treatment of PPHN.
Studies into NEC
Necrotizing enterocolitis, which can cause destruction of the intestines, is extremely rare in healthy newborns. Among pre-term hospitalized infants, however, it is the most common and serious gastrointestinal disorder diagnosed. In collaboration with the Department of Pediatric Surgery, the Division of Neonatology is currently investigating the role of mesenteric vasculature in the pathogenesis of necrotizing enterocolitis.
World-class research facility
Researchers at the Division are well placed to undertake their research. Working at a facility that is almost unique in this country, investigators are able to create various disease models in pre-term lambs. The center is one of two in the United States that can accommodate long-term ventilation of lambs with PPHN. Established for over 20 years, its purpose has remained constant: to discover new treatments for the disease. Working in conjunction with Northwestern University, the Division has received a grant to study anti-oxidants such as superoxide dismutase in the treatment of PPHN.
The Division is also the recipient of a PROP (Prematurity and Respiratory Outcomes Program) grant and a TOLSURF (Trial Of Late SURFactant) grant aimed at the prevention of Bronchopulmonary dysplasia (BPD). Recently, the Division along with the Division of Neonatology at Rochester, has joined the Neonatal Research Network established by the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD).
Comprised of a team of neonatologists along with nursing and other clinical staff specializing in the critical care of newborns, the Neonatal Intensive Care Unit serves Buffalo and Western New York and the surrounding regions. The 64-bed mostly private room NICU admits over 850 babies each year and has an average daily census of 52 babies.
Approximately one-third of admissions are transported from outlying hospitals by the active Neonatal Transport Team, led by Dr. Vivien Carrion. This team consists of neonatal nurse practitioners and specially trained neonatal respiratory therapists, who are always ready to stabilize and transport any infant in the region to Oishei Children's Hospital.