September 24, 2021
St. David’s HealthCare Neonatal Intensive Care Unit research is focused around imaging, devices, neuroprotectants, and life-saving advances to improve the high-risk infant and mother outcomes. Physician researchers across St. David’s are involved in studies of cutting-edge technologies and treatments. A few major areas of NICU studies are around some of the most crucial to improving a neonate’s health. Some examples include:
Retinopathy of Prematurity
Retinopathy of prematurity (ROP) is a disease that occurs in premature babies. It causes abnormal blood vessels to grow in the retina, the layer of nerve tissue in the eye that enables sight. This growth can cause the retina to detach from the back of the eye, leading to blindness.
Gastroschisis Surgical Approach and Neonatal Outcomes
Gastroschisis is a congenital defect of the abdominal wall where the abdominal contents, most commonly intestines, herniate through the defect. In recent years, the incidence of gastroschisis has been climbing and is now between 4-5/10,000 live births. There are two primary types of surgical repair for gastroschisis: primary closure of the abdominal wall within hours of birth and silo placement with staged reduction and closure days after birth. Although there have been no randomized controlled trials comparing the outcomes of patients treated with the two different types of repairs, a meta-analysis suggests that infants who undergo silo placement with staged reduction are slower to reach full enteral feeding volumes, may require more days on the ventilator, and have longer hospital stays. In the last 10 years in Austin, Texas, the surgical management of infants with gastroschisis shifted from primarily placing silos and performing staged reduction and closure to primary closure within hours of birth. Our research compares the characteristics and morbidities of infants with gastroschisis over the last 10 years to determine changes in the outcomes of infants as the preferred method of surgical repair has changed.
Improving Oxygen Safety in NICU’s: Quality Improvement
Management of oxygenation for premature infants cared for in the NICU is complex. Too much or too little oxygen is problematic, especially for infants born less than 28 weeks and less than 1500g. The level of oxygenation influences mortality and the development of morbidities including retinopathy of prematurity (ROP), chronic lung disease (CLD), neurodevelopmental outcomes, and necrotizing enterocolitis (NEC). This type of research is to improve the safety and effective use of supplemental oxygen therapy and to reduce the amount of time spent outside the oxygen saturation target range by applying alarm safety principles to pulse oximetry.
Umbilical Cord Blood Gene Sequencing
Umbilical cord blood is a unique source of stem cells, cells capable of transitioning into different cellular subtypes. These stem cells can be influenced by events in both the fetus as well as the pregnant mother, prior to delivery. The prenatal environment can have lifelong influences on stem cells and other cellular subtypes via epigenetic programming, whereby protein expression can be changed within and around the cell, having long-lasting effects. A unique, National Institutes of Health-funded study aims to examine the genetic imprinting, or epigenetics, of umbilical cord stem cells in response to maternal medication received during the pregnancy. Our physician research team has identified and selected a panel of genes known to be associated with neuropsychiatric disorders in adulthood. They hypothesize that the risk for certain disorders may be linked to cellular programming in the prenatal environment, and may be linked to maternal medication effects on the developing infant.
Infants who stay in the NICU may be hospitalized for many weeks, and often months at a time before they are healthy enough to be discharged home. During their stay, these newborns may be exposed not only to medications, tests and artificial support, but also to environmental influences such as disturbed sleep/wake cycles, sounds that may be foreign to them such as monitors, and the incubator itself, which provides heat to the growing infant. The hospitalization represents the first time the baby’s brain undergoes postnatal experiences, which may affect the behavior or neurological outcome. The goal is to learn more about how different issues that arise in the Neonatal Intensive Care Unit may affect the brain development of a growing child and then use the data to make improvements in care for infants most at risk.
We are participating in a project with Dell Medical School to study ways to improve access to long-acting reversible contraception (LARC) (i.e., an intrauterine device or hormonal implant) during the immediate postpartum period (i.e., after delivery and prior to hospital discharge) among Texas women enrolled in Medicaid. We are participating in evaluating an intervention utilizing community health workers, and delivered through Sendero Health Plans, to help pregnant women enrolled in Medicaid in Texas obtain desired immediate postpartum LARC. Another aim of this project is to document the process and identify facilitators and barriers for Medicaid-enrolled women to obtain immediate postpartum LARC in Travis County, Texas.
Maternal and Fetal Medicine
St. David’s Women’s Center of Texas at North Austin Medical Center, in collaboration with Austin Maternal-Fetal Medicine, has a robust perinatal research division currently engaging in women’s health research projects. Research includes studies on birth outcomes, preterm deliveries, cervical cerclage placentas in twin pregnancies, as well as multiple other studies. Our Maternal and Fetal Medicine physician researchers are involved in research collaboration with the National Institutes of Health (NIH), industry partners, St. David’s Women’s Center of Texas at St. David’s North Austin Medical Center, The University of Texas Medical Branch Galveston, and The State of Texas Newborn Screening Program. All of the national, multicenter trials are all focused on improving mother and infant outcomes. Some study topics include:
Our providers collaborate with industry and the State of Texas Newborn Screening Program to track birth outcomes and perinatal correlates to the noninvasive prenatal screening test for risk of genetic disorders as early as nine weeks through a simple blood draw from the mother’s arm. As part of this study, pregnant mothers in the general population elect prenatal screening test as part of their routine care. This type of study can differentiate between maternal and fetal DNA to detect if there are any tiny missing pieces of DNA at the sub-chromosomal level that could indicate clinically important disorders. Early diagnosis can facilitate delivery and treatment as needed.
Predicting Preterm Delivery
Studies are ongoing around using tests for prediction of preterm delivery within 7 or 14 days from testing and to compare it with traditional cervical length (CL) measurements by transvaginal ultrasound (15 mm cut-off). While not sufficiently predictive of imminent delivery among patients with signs of preterm labor, these type of biomarker tests are the next wave in predicting with more certainty preterm birth risk which could possibly reduce unnecessary patient transfers and potentially reduce length of stay.
Prevention of Premature Twin Delivery
St. David’s MFM physician providers and researchers are conducting studies for the prevention of complicated preterm births for those expecting twins and have cervical insufficiency. A cerclage placement is the placement of stitches in the cervix to hold it closed to keep a weak cervix from opening too early. When the cervix starts to shorten and open too early during pregnancy it could lead to preterm births. St. David’s MFM physicians stay current by participating in the most advanced studies to help improve pregnancy outcomes.
Premature rupture of membranes (PROM)
Studies are ongoing at St. David’s Women’s Center of Texas to reduce pregnancy complications. One such complication is the preterm premature rupture of membranes before labor begins. When the amniotic membrane sac ruptures before week 37 of pregnancy, it is called preterm premature rupture of membranes (PPROM). PROM and PPROM is significant in that it is a complicating factor during pregnancy. Other complications may occur with PROM including early detachment of the placenta, compression of the umbilical cord, cesarean birth and postpartum risk of infection, and higher chance of a baby born early. The MFM physicians have also participated in multi-center national studies examining the use of antibiotics and dosing strategies to prolong pregnancy.
Please email the Office of Research if you have interest in collaborating with St. David’s