UCSF Children’s Hospital has opened an innovative new clinical unit focusing on the infant brain that is the first facility of its kind in the United States. The unit brings together specialized treatment for infants who show signs of brain damage at birth – and are at-risk for developing cerebral palsy, mental retardation and other cognitive disorders – with clinical research.
The new Neuro-Intensive Care Nursery (NICN) is a state-of-the-art newborn care unit designed to host clinical trials and bring the latest cutting-edge treatments to patients.
“My hope is that by bringing scientists and clinicians together in the NICN we will be able to establish the root causes of brain damage in infants so that we can offer patients and their families real therapeutic options,” Rowitch said.
A team of UCSF doctors specializing in newborn care, the pediatric brain, and pediatric brain imaging developed the NICN under the direction of David Rowitch, MD, PhD, chief of neonatology and a Howard Hughes Medical Institute investigator; Donna Ferriero, MD, chief of pediatric neurology and James Barkovich, MD, chief of pediatric neuroradiology.
“Our highly skilled team of experts is well-equipped to address the critical need for improved care of the infant brain,” said Sam Hawgood, MB, BS, chair of the UCSF Department of Pediatrics. “By offering the most advanced treatments and hosting clinical trials, the new NICN is positioned to have a tremendous impact on care today and for years to come.”
The type of specialized care for the infant brain that is offered at the NICN is already in high demand, Rowitch noted. Within the first month of the NICN opening in mid-summer, the number of patients referred to UCSF Children’s Hospital for pediatric neurological care quadrupled.
What sets the NICN apart from other centers, according to Rowitch, is the integration of several components that means the best in patient care now and the ongoing development of promising new therapies, including a multidisciplinary team of doctors who represent all relevant medical specialties, a specialized nursing team, long-term follow-up of patients, and clinical trials funded by NIH and other sources.
Newborn brain damage is the leading cause of mental retardation, developmental delay and cerebral palsy in the U.S., according to Rowitch. Among all babies born very prematurely, five to 15 percent go on to develop cerebral palsy, and 25 to 50 percent develop cognitive disorders or a learning disability. The cost of treating cerebral palsy alone exceeds $35 billion annually, according to the March of Dimes Foundation.
“It must be remembered that a baby with a neurological disability will live decades after the insult with this burden,” Ferriero said.
The opening of the NICN comes at an important time, as the last few decades have seen an increase in the number of infants who show signs of brain damage shortly after birth. This increase is primarily due to a corresponding increase in the survival rate of extremely premature infants – known to be much more susceptible to brain damage than full-term infants.
Although advanced neonatal care has enabled doctors to keep preterm infants alive, there is currently a lack of therapies that prevent or diminish brain damage in these cases. Rowitch says he hopes that the work done at the NICN will play an instrumental role in the development of new therapies for premature babies at high risk for brain damage.
“We currently lack neuroprotective therapies for these tiny babies,” he said. “They face a rough road and unfortunately many of them develop significant brain injury. It is clear that we must be able to deliver a better standard of care in the future to reduce the impact of neurological injury in this very fragile patient population.”
One treatment now used by the NICN team is hypothermia, which involves cooling a newborn’s brain and body by a few degrees immediately after birth. Research has shown that hypothermia treatment within the first six hours of an infant’s life can help prevent or minimize the long-term consequences of brain damage caused by a loss of oxygen during birth. Hypothermia treatments, however, have only been tested in full-term infants.
“Current research suggests that we can diminish the mortality and severe disability with the use of hypothermia in some newborns,” Ferriero explained. “However, the protection is not complete, so we must continue searching for additional therapies that aid the newborn brain in its ability to repair itself.
Another key component of the new NICN is the use of an advanced neonatal brain monitoring system, called cerebral function monitoring or amplitude integrated electroencephalography (aEEG), which provides a window into the brain activity of newborns. According to Yao Sun, MD, PhD, director of neonatal clinical programs at UCSF, this type of intensive monitoring is a routine part of the clinical care in the NICN, while most other nurseries use it only when an infant shows signs of seizure.
“By monitoring the electrical function of the newborn brain under various conditions of illness and stress, we will gain a better understanding of how our treatments affect brain function and the risk of injury. This, in turn, will lead to better treatments to optimize neurological outcome,” Sun explained.
The nursery also uses an MRI-compatible incubator, which Barkovich developed in order to photograph the brain anatomy in extremely premature babies who need a carefully controlled environment. Researchers at the NICN are using the information gathered from both the incubator MRI and the cerebral function monitoring system to learn more about brain development in preterm babies.
The NICN is the main clinical branch of the Newborn Brain Research Institute (NBRI), founded at UCSF in 2006. The goal of both the NBRI and the NICN is to discover the root causes of brain damage in infants and to develop and test new treatments, using translational research that integrates the work of basic scientists and clinicians. In one of the initial steps of this research, Rowitch and Arturo Alvarez-Buylla, PhD, of the UCSF Institute for Regeneration Medicine, are investigating the key attributes of stem cells in the developing brain.
The NICN is supported through private donations and the UCSF Medical Center. Clinical and basic research is supported by the National Institute of Neurological Disorders and Stroke, the National Institute of Child Health and Development and the Howard Hughes Medical Institute.
One of the nation’s top children’s hospitals, UCSF Children’s Hospital creates an environment where children and their families find compassionate care at the healing edge of scientific discovery, with more than 150 experts in 50 medical specialties serving patients throughout Northern California and beyond. The hospital admits about 5,000 children each year, including 2,000 babies born in the hospital.
UCSF is a leading university dedicated to promoting health worldwide through advanced biomedical research, graduate-level education in the life sciences and health professions, and excellence in patient care. For further information, visit