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Neonatology/Perinatology


Human Infant Physiology Laboratory

Rakesh Sahni, Sudha Kashyap, Helen Towers

Despite the many exciting advances being made daily in molecular biology and molecular genetics, investigation of intact, functioning human beings still forms the foundation of clinical research. This is particularly true of developmental human biology. In some ways, studies of human infants are inordinately difficult. Each infant is biologically unique, measurements must be noninvasive and are often unsystematic, important variables are necessarily uncontrolled or unmeasurable, and studies are often performed while infants are receiving aggressive and confounding therapies. But there are advantages as well. Growing low birth weight infants are available for long periods of observation, their intake and output can be very accurately measured and controlled, physical activity is much easier to quantify, and they can be studied serially across a wide window of development, during which time body mass may double, or even triple. Our former director, Dr. Stanley James was among the first neonatologists to appreciate that a special patient care site(s), complete with pre-configured, hard-wired instrumentation would facilitate clinical research in the NICU without impeding nursing care. Over the last two decades the Human Infant Physiology Laboratory at Children's Hospital has focused on the study of low birth weight infants under actual nursing conditions. The theme that ties together all studies from this facility is the measurement of energy expenditure. Energy expenditure must be investigated from both sides of the equation. Over the last few years we have studied the relationships between alterations in the amount and quality of dietary intake and the associated changes in gaseous metabolism (oxygen consumption and carbon dioxide consumption). Recently, as evidence accumulates that early dietary intake may influence cardiovascualar health in adulthood, we have expanded our focus to include studies of the effects of diet on cardiovascular and metabolic function with an eye on possible mechanisms for "metabolic programming." Another major area of interest for our group is the effect of prone vs supine positioning on the autonomic control of the heart and lungs.

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Primate Research

Buddy Stark, Marianne Garland

In the tradition of its founder Dr. Stanley James, the Perinatal Physiology Laboratory continues as a multidisciplinary center of research emphasizing investigations into the causes and consequences of oxygen and substrate deprivation during early development. Raymond Stark is the principal investigator of the multidisciplinary Perinatal Emphasis Research Center from the NICHD. Dr. Stark's project evaluates fetal cardiorespiratory and neurobehavioral function associated with sleep state and circadian rhythm to understand differences between the normal variation in and the adaptive alterations induced by oxygen deprivation. In separate grants, Dr. Marianne Garland has defined kinetic models to define the fetal drug exposure from maternal drug levels through research on the placental transfer and fetal metabolism of anti-AIDS drugs and opiates in the non-human primate model. Further studies in this model evaluate the potential for newly developed antigen delivery system to induce immune response in the fetus and the possibility of intrauterine immunization against specific infectious agents that risk fetal well-being.

Divisional Core-Lab of Developmental Biology

Vadim Ten

The main focus is research on role of mitochondrial dysfunction in pathogenesis of cellular injury in neonatal diseases: asphyxia, BPD, NEC. Specifically, we study changes in mitochondrial production of ATP and formation of reactive oxygen species, membrane potential, Ca++ upload capacity in response to the modeling of the disease of our interest. The goal is to identify a molecular target for attenuation of mitochondrial dysfunction and to offer clinically relevant strategy to protect cells from injurious factors (ischemia, oxidative stress, inflammation).


Prognosis, Risk Perception, Informed Consent and Decision Making in Neonatal Care

K. Orfali

In neonatal care many crucially important decisions involve assessing long term consequences in terms of impairments and disabilities, and reliable medical and statistical evidence on the probabilities of the various outcomes often fail to be available. In such a context, the prerequisite of informed consent for parents, a crucial aspect of medical ethics and bedside care, may become elusive because of the potentially subjective nature of the neonatologists prognosis. Dr Orfali's interdisciplinary and international research focuses on risk perception and assessment, exploring how neonatologists elaborate a prognosis and make decisions in critical uncertain cases, when statistical evidence does not exist and probabilistic assessments cannot even be derived from a consensual professional opinion. Among the outcomes of the study, she hopes to develop a practical tool for physician to assess their optimism and pessimism index compared to peers. Other topics of interest are related to ethical dilemmas, parental choices and life and death decision-making as well as shifting paradigms in neonatal care in a cross-cultural perspective.

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Epidemiology Studies

David Bateman

Dr. Bateman has participated in several observational epidemiological studies related to infants born at Harlem Hospital. These include descriptions of the effect of intrauterine cocaine exposure on the growth and neurological status of newborns,the neurodevelopment of children exposed to cocaine in utero,the risk factors associated with maternal HIV infection and congenital syphilis, and the outcome of unattended out of hospital births. Related studies include cost estimates of intrauterine cocaine exposure and congenital syphilis.

Decision Making in the Care of Extremely Premature Infants

J.M. Lorenz

There are many complex issues involved in balancing maternal and neonatal risks and benefits of intrapartum and neonatal care of the extremely premature fetus or newborn. These include maternal morbidity attendant to interventions to prolong pregnancy in the face of premature labor or complications of pregnancy, long-term survival and morbidity of the infant, suffering of the infant and family, parental values and autonomy, and consumption of limited communal resources. Informed decisions about whether to administer intensive care to extremely premature infants require the best data that is feasibly available, as well as presentation of this information to the parents in a way that is most comprehendable. Because communal resources are invariably expended in the care of these infants and because infants are valued in and of themselves, physicians also need more explicit direction from the larger community about the range of options that may be reasonably offered to parents regarding the care of their extremely premature infant. Dr. Lorenz' research focuses on these related issues: first, defining long-term outcomes of the extremely premature infant and exploring the effect of difference in the application of intensive care on these outcomes; second, investigating the effect on parental decisions of varying methods of presenting relevant information to parents; and, thirdly, developing a systematic approach to applying cost-effectiveness data and balancing competing moral values in policy formulation.

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Last updated 10/22/07

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