Research and clinical care go hand-in-hand in the Division of Neonatology, which is part of UBMD Pediatrics. These physicians provide the highest level of specialty care available for newborns at Oishei Children's Hospital through their research advances. These discoveries bring about direct improvements in the care of the hospital’s youngest, and perhaps the most vulnerable patients.
Our Division’s clinical and translational research endeavors over the last decade have led the way in understanding and managing several neonatal problems.
World-Class Research Facility: Center for Developmental Biology of the Lung
For over 20 years, the purpose of our research facility has remained constant: to discover new treatments for neonatal conditions. Researchers in our Division are well equipped and supported to advance neonatal research. The team includes physicians, trainees and several dedicated research technicians. Working at one of only a few facilities capable of this type of research in the country, investigators are able to create various disease models in pre-term and term animal models. Earlier studies in the lab led to several critical discoveries in the development of surfactant for use in preterm infants and in management of PPHN (persistent pulmonary hypertension of the newborn). Divisional faculty have evaluated innovative modes of neonatal ventilation such as liquid ventilation at our research center. Additionally, in collaboration with the Department of Pediatric Surgery, our faculty have investigated the role of mesenteric vasculature in the pathogenesis of necrotizing enterocolitis, a devastating neonatal disease of preterm infants.
The perinatal asphyxiated lamb model finessed at this state of the art research facility has been the model for several studies in neonatal resuscitation that have received NIH funding (Drs. Nair and Chandrasekharan). Several faculty (Drs. Berkelhamer, Rawat, Chandrasekharan, Nair, Mathew, and Kumar) have received funding from the neonatal resuscitation program (NRP), American Academy of Pediatrics (AAP) in the last decade due to the invaluable physiological data yielded from this unique model.
Current Focus Areas of Divisional Research
At present, several investigators in our Division are conducting research focused on neonatal resuscitation.
- evaluating benefits of delayed cord clamping and cord milking in the compromised newborn, term and preterm
- finding the optimum oxygen concentration to be used during resuscitation at various gestations
- evaluating use of feedback devices such as end tidal CO2 monitors in the delivery room
- use of appropriate medications during resuscitation such as epinephrine and vasopressin, as well as determining the route of administration, appropriate dose and timing of these medications
- utilizing the University at Buffalo’s state of the art genomic center (Center of Excellence), investigators are also evaluating transfer of stem cells and changes in miRNA during birth, asphyxia and 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 intact survival.
Hyperoxia-Induced Lung Injury
Preterm neonates with underdeveloped lungs often require oxygen after birth. While it is life-saving, high levels of oxygen also have negative effects on the lungs. Researchers in our division are investigating the mechanisms by which hyperoxia causes lung injury as well as agents that could mitigate this injury.
E-Cigarettes and Their Effect on the Fetus
There is very little known about the effects of e-cigarettes on the fetus and neonate, yet more and more young adults are using this product. In unique studies currently being conducted by divisional faculty, the role of e-cigarettes (both nicotine and additives) on lung development is being evaluated.
Clinical Trials to Improve Patient Outcomes
We are a participating center in the Neonatal Research Network (NRN), established by the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD). With the support of a dedicated team of clinical research coordinators, multiple trials are currently active that aim to improve care for newborns.
Some of these trials include:
- evaluating the role of Darbepoietin in long term neurodevelopment in preterm infants
- determining the best management of Patent Ductus Arteriosus
- exploring the role of therapeutic hypothermia in preterm infants with hypoxic ischemic encephalopathy (HIE)
Additional National Institute of Health (NIH) studies:
We also are participating in the Developmental Impact of Neonatal Exposures (DINE) multicenter study which is part of the Environmental Influences on Child Health Outcomes (ECHO) program at the NIH.
Our Division was previously the recipient of a PROP (Prematurity and Respiratory Outcomes Program) grant and a TOLSURF (Trial Of Late SURFactant) grant aimed at the prevention and understanding of bronchopulmonary dysplasia (BPD).
Participation in these clinical trial ensures that the latest therapies and monitoring techniques are available to our patient population.
Quality improvement projects for patient safety
Participation in state-wide and locally initiated quality improvement programs ensure optimal care to our neonates. Led by divisional faculty, several successful initiatives have occurred in the last 5 years and include:
- a significant reduction in CLABSI (central line associated bloodstream infections)
- optimizing nutrition and growth for infants born before 32 weeks of gestation
- reducing the use of antibiotics in the NICU
- projects designed to successfully improve teamwork among the many providers and ancillary services in the NICU
Impacting Treatment Before Arrival to Oishei Children’s Hospital
Approximately one-third of admissions to our 64-bed NICU are transported from hospitals in Western New York and the surrounding regions. The team is led by Dr. Vivien Carrion and consists of advanced transport practitioners (NNPs/PAs) and neonatal respiratory therapists. An integral component of the Regional Perinatal Center, the team is available 24/7 to stabilize and transport any sick infant in the Western New York region to Oishei Children's Hospital. They have the capability to transfer babies requiring high level of respiratory and circulatory support such as high frequency ventilation and inhaled Nitric Oxide. In addition, our team is equipped to provide therapeutic hypothermia during the transport, which is a time sensitive treatment used to prevent ongoing neurologic injury for infants with hypoxic ischemic encephalopathy.