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News and Features Nichd Neonatal Research Network Interventional Studies Target High Risk Populations

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News and Features Nichd Neonatal Research Network Interventional Studies Target High Risk Populations

The NICHD Neonatal Research Network centers perform clinical research to seek ways to improve the outcomes of both term and preterm high-risk infants. Last year the Children's Mercy-Truman-UMKC Center became one of 18 NIH-funded Neonatal Research Network centers in the nation.

Led by William Truog, MD, Sosland Chair in Neonatal Research at Children's Mercy and Professor and Associate Chair of the Department of Pediatrics at the University of Missouri Kansas City School of Medicine, Children's Mercy is currently involved in four important interventional studies, in conjunction with other institutions within the NICHD Network. Each of these studies could have lasting implications for high-risk populations.

Two studies concern babies that have suffered birth asphyxia just before or after delivery, which puts them at high risk for brain injury, cerebral palsy or other debilitating conditions. About a decade ago it was found that providing therapeutic cooling for these babies resulted in more positive long-term outcomes.

One study is looking at the potential benefits of cooling for longer periods (five days vs. three days), or at lower temperatures (32º C vs. 33.5º C). The study also looks at other slight variations in the lengths of cooling periods and temperatures. This study was already under way when Children's Mercy joined the Network.

Another similar study is attempting to determine whether there are additional benefits in starting the cooling therapy between 6 and 24 hours after birth. "This is a prime example of a study that wouldn't be possible without such an expansive network of participating institutions, as the test pool consists solely of babies who for some reason couldn't begin being cooled within the first six hours," Dr. Truog says.

A recently begun study is measuring the benefits of using hydrocortisone on babies born before 30 weeks. For years, hydrocortisone took a back seat to dexamethasone, until problems with that drug were discovered after children were evaluated at the age of two. Children's Mercy is active in getting babies enrolled in this study of the benefits of hydrocortisone in infants' third and fourth weeks of life, with the goal of diminishing or reducing lung injuries due to prematurity.

Lastly, Children's Mercy is testing one of two different kinds of surgery for premature babies who have developed intestinal problems, includingnecrotizing enterocolitis, an uncommon but devastating condition. There aren't many subjects for this study, which requires two years to determine which procedure produces the better outcome.

"The network sponsors this study for babies that develop a need for intervention, and families allow the initial operation to be picked by chance, to best determine which approach produces a better overall outcome," Dr. Truog says.

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