Neonatology and Perinatology

Neonatology and Perinatology

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Division: 
Neonatology and Perinatology
Director: 
Richard A. Polin, MD
Email: 
rap32@columbia.edu
Phone: 
(212) 305-5827
Administrator: 
Miriam Diaz
Phone: 
(212) 305-5827
Fax: 
(212) 305-7086

NewYork-Presbyterian Morgan Stanley Children's Hospital  is the hub of the Regional Perinatal Network, which links hospitals throughout the tri-state area. Through this network, high-risk infants are transported to our neonatal intensive care unit by helicopter or mobile intensive care.

The Neonatal Intensive Care Unit at Morgan Stanley Children's Hospital  is noted for its contributions to the field of neonatology and there is a long history of excellence in Neonatal and Perinatal clinical care and research. Since the founding of the division in May of 1959, many of its clinician-scientists have contributed substantively to the field. These include Drs. L. Stanley James and Virginia Apgar who were among the first investigators to measure the acid-base and oxygen status in the neonatal intensive care unit. In the same setting, Drs. William Silverman and Jack Sinclair undertook the first controlled clinical trials in neonatal patients. These studies are the original models for evidence-based practice in neonatal intensive care. In addition, Drs. Mervin Susser, Zina Stein, and Nigel Paneth helped establish the Gertrude H. Sergievski Institute at Columbia University, one of the first centers to foster Perinatal and Pediatric Epidemiology. The Division also has a long-standing interest in neurodevelopment and has well-established collaborations with the New York State Psychiatric Institute.

Neonatology provides a unique opportunity for longitudinal research of infant development, especially in infants born extremely prematurely. In some ways, studies of human infants are inordinately difficult, however, the growing low birth weight infant is available for long periods of observation and they can be studied serially across a wide window of development, during which time body mass may double, or even triple. Over the last two decades the Human Infant Physiology Laboratory 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. Recent evidence suggests that early dietary intake may influence cardiovascular health in adulthood. Therefore, we have expanded our focus to include studies of the effects of diet on cardiovascular and metabolic function with an eye on defining possible mechanisms for "metabolic programming." Another major area of interest for our group is the effect of body positioning on the autonomic control of the heart and lungs. Those studies are especially relevant to infants at risk for sudden infant death syndrome.

The molecular and structural biology laboratory within the Division of Neonatology and Perinatology under the leadership of Thomas Diacovo is studying adhesive interactions between circulating blood cells and endothelium an interface that may affect inflammatory conditions in humans associated with various disease states such as atherosclerosis. Another focus of the laboratory is to elucidate mechanisms that promote platelet interactions with von Willebrand factor (VWF) that will ultimately expedite preclinical screening of antithrombotic therapies that target human platelets.

The laboratory of developmental biology under the direction of Vadim Ten, and Veniamin Ratner is studying the role of mitochondrial dysfunction in pathogenesis of cellular injury in neonatal diseases such as, hypoxic-ischemic brain injury, acute and chronic lung injury, and necrotizing enterocolitis.

Dr. Kristina Orfali is 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. Among the outcomes of the study, she hopes to develop a practical tool for physicians to assess their optimism and pessimism compared to peers. In related work Dr. Jack Lorenz is defining long-term outcomes of the extremely premature infant with respect to the application of intensive care and he is developing a systematic approach to applying cost-effectiveness data and balancing competing moral values in policy formulation.

The research of Drs. Buddy Stark, Philip Grieve, Joseph Isler is focused on the differences in the development of brain function between extremely premature and term infants and their relationship to perinatal risks for poor neurodevelopmental outcome. They are developing data analysis and modeling techniques aimed at understanding how these neural mechanisms can be studied in EEG and ERP recordings. Dr. Tove Rosen, in collaboration with colleagues in the Department of Pharmacology have developed a dog model to study a gene therapy approach in the prevention and treatment of cardiac arrhythmias. In addition she is evaluating the effects of drugs of abuse on brain structure and metabolite concentrations as well as the behavioral correlates in infants and children who were exposed to these drugs in utero and a non-exposed control group.

The work of Dr. Elvira Parravicini is studying kidney development in newborn infants, her current research focuses on the study of urinary Neutrophil Gelatinase-Associated Lipocalin (UNGAL) as an early biomarker of acute renal failure and sepsis in very low birth weight (VLBW) infants.