Critical Care

Research Activities

Development of lung T cell responses in infant respiratory immunity
Daily endotracheal or tracheostomy suctioning specimens from children with a viral respiratory tract infection will be studied for any alteration in phenotype and function of pulmonary lymphocytes. John Scott Baird, MD

HALF PINT: Heart And Lung Failure – Pediatric Insulin Trial
Multi-center, randomized control trial of 2 treatment regimens for the management of hyperglycemia associated with cardiac or respiratory critical illness. Katherine Biagas, MD, NIH/ NHLBI (Biagas, site PI)

HAI in Pediatric Cardiac Surgery
Epidemiology of healthcare acquired infections in children undergoing cardiac surgery. Katherine Biagas, MD

Pediatric International Nutrition Survey Multi-institutional point prevalence study of the nutritional practices in support of PICU patients. Katherine Biagas, MD

NEAR-4-KIDS Multi-center observational quality improvement project of tracheal intubation practice in PICUs. Katherine Biagas, MD, Private foundation funding

Evoked Potentials as a Probe to Measure and Improve the Utility of EEG in ICU Patients Neurocritical care requires the early detection of changes in neural function at an early, still reversible, stage. The most used modality, passive EEG recording, can be of reduced and unquantifiable quality in the most critically-ill, at risk, patients. This project introduces a stimulation paradigm as an add-on to existing EEG techniques which can be used as a repeated measure to probe and increase the signal to noise ratio of EEG making it a better detector of neurologic events. Joshua Cappell, MD

The consent process for organ donation after cardiac death Follow up to OPO DCD consent study published in 2011. Cross sectional survey of all (220) U.S. transplant hospitals regarding their DCD policies – specifically information related to the consent/authorization process for DCD. The online survey used for the previous study is being adapted to transplant hospital personnel. The actual DCD policies themselves will also be requested for direct data retrieval regarding consent policy. Data of secondary importance on TC DCD experience (number of cases, etc.) will also be surveyed from the respondents. George Hardart, MD, MPH

Attitudes and preferences of U.S. cardiac surgeons regarding surgical options for children of Jehovah’s Witnesses with congenital heart disease With Dr. Emile Bacha of Pediatric Cardiac Surgery. Study of the Congenital Heart Surgeons Society (consisting of approximately 100 surgeons) regarding their decision-making strategy in such situations. Cross-sectional, scenario based scientific survey. Specifically, a hypothetical case of an infant with congestive heart failure secondary to a ventricular septal defect requiring surgery will be presented. Surgeons will be offered a variety of management strategies that expose the infant to various degrees of medical risk for the sake of avoiding blood transfusions. Data will include their preferences, their assessment of risk, and the justification for their preference. George Hardart, MD, MPH

Study of U.S. pediatric ethics committees in the era of hospital credentialing of clinical ethicists Cross-sectional survey of NACHRI hospitals. Critical data being collected include the institutional structure of the PECs as well as the typical number of ethics consults done per year. Additional data will encompass composition of committee, training of consults and leaders, types of consults, structure of consult teams. George Hardart, MD, MPH

Electronic Communication for Antimicrobial Management (ECAM) To design an electronic clinical decision support tool for antibiotic prescribing for neonatal intensive care clinicians. R. Stanley Hum, MD

Improving Antimicrovial Prescribing Practices in Neonatal Intensive Care Unit (iNAP) To measure the impact of interdisciplinary interventions to improve antibiotic prescribing on inappropriate antimicrobial use and antibiotic resistance. R. Stanley Hum, MD

Intensive care clinician communication To understand the effect of electronic handover tools on communication in the pediatric intensive care unit. R. Stanley Hum, MD

The role of neural stem cells in traumatic brain injury This proposal uses novel mouse genetic models to determine whether injury-induced activation of stem cells improves functional recovery after traumatic brain injury. Steven Kernie, MD, NIH/NINDS -- RO1 NS048192-01 Kernie (PI)

Modeling cerebral palsy by selective ablation of oligodendrocyte progenitors This proposal uses novel mouse genetic models to ablate myelin-producing oligodendrocytes in order to model cerebral palsy in mice and test experimental reagents as potential therapy. Steven Kernie, MD

Role of ancillary proteins in Sinus node dysfunction in Long QT Syndrome: an effect on pacemaker current To study the effect of Long QT mutants on biophysical properties of pacemaker channels and to explore the role of these effects in sinus node dysfunction in Long QT syndrome. Pooja Kulkarni (Nawathe), MD

Patient-specific iPSCs to explore complex pacemaking effects of a channel beta-subunit mutation To identify the role of Long QT syndrome 6 mutation in sinus node dysfunction, biophysical characteristics of different currents contributing to pacemaking will be studied in cardiac lineage cells derived from iPSCs from our index patient. Pooja Kulkarni (Nawathe), MD

Ethics of non-therapeutic research involving children Part 1. Analysis of the ethical basis for and ethical problems with non-therapeutic research involving children Part 2. Evaluation of parental opinions of non-therapeutic research involving children with and without significant medical conditions. Marilyn Morris, MD

Compensation for pediatric research Evaluation of potential for financial motivations for children and their parents to participate in pediatric research. Marilyn Morris, MD

Aldose Reductase (AR)- Receptor for Advanced Glycation Endproducts (RAGE) axis in septic mice heart
Systemic Inflammation is induced by using cecal ligation and puncture that results in polymicrobial sepsis in mice. We are utilizing this model to study the role of an enzyme AR that is implicated in glucose metabolism and RAGE in cardiac dysfunction that follows sepsis. Thyyar M. Ravindranath, MD

Cerebral mitochondrial function in systemic inflammatory response Our goal is to understand the pathophysiology of septic encephalopathy in human neonate and infant population by using a clinically relevant animal model. Thyyar M. Ravindranath, MD

Adaptive immune responses in infants and children following viral lower respiratory tract infection The aim of present research is to investigate the role of lymphocyte subsets as well as inflammatory cytokines in infants and children with viral respiratory tract infections of different severity. Thyyar M. Ravindranath, MD

Therapeutic Hypothermia After Pediatric Cardiac Arrest (The THAPCA Trials) The THAPCA Trials are two prospective randomized controlled trials of therapeutic hypothermia after cardiac arrest in children. Each THAPCA Trial will be analyzed as an intention to treat study. The THAPCA Trials include one for out-of-hospital cardiac arrests (THAPCA-OH Trial), and one for in-hospital cardiac arrests (THAPCA-IH Trial). These trials will be analyzed separately, because etiologies and patient outcomes of these groups are substantially different. Charles Schleien, MD, MBA. NIH/NHLBI (Schleien, site PI)

The Response to Emergencies in American Pediatric Hospitals This project is a survey of the major children’s hospitals in the country, looking to characterize the standard of care for urgent and emergent response in pediatrics. Anita Sen, MD

HMGA2 as a marker for Lymphangioleiomyomatosis The purpose of this project is to determine whether a non-invasive peripheral blood marker can be used to screen for this rare lung disease. Anita Sen, MD

Antioxidants in the prevention of lung injury We have identified several new antioxidants that appear to confer protection from lung injury. We seek to test these compounds in live mouse lung injury models, including both an acute lung injury and an emphysema model. Anita Sen, MD

Protection from acute lung injury by the administration of omega-3 fatty acids Collaborating with the department of Nutrition, we plan to treat mice with a special cocktail of omega-3 fatty acids to see if this treatment protects them from the harmful effects of acute lung injury using a hyperoxia model. Anita Sen, MD