Summer 2007

Building a Neonatal Neurological ICU

David Rowitch, M.D., Ph.D.

David Rowitch, M.D., Ph.D., has a dream, one that lured him from Harvard Medical School to UCSF. That dream is to develop a fully integrated translational research program to study and treat neurological damage in neonates, the first such program in the nation.

Neurological damage in neonates is on the rise, mostly due to recent increases in the survival rate of extremely premature infants. Such premature infants go on to develop cerebral palsy in 5 percent to 15 percent of cases, and 25 percent to 50 percent develop cognitive disorders or learning dysfunction. The cost of treating cerebral palsy itself exceeds $35 billion per year, according to the March of Dimes Foundation. There are currently no therapies available to prevent or diminish neurological damage in very preterm infants.

At UCSF, Rowitch and his colleagues, including Donna Ferriero, M.D., chief of Pediatric Neurology, and A. James Barkovich, M.D., chief of Pediatric Neuroradiology, are building a fully integrated program for neonatal neurological care, combining the newly founded Newborn Brain Research Institute (NBRI) and Neurodevelopmental Intensive Care Nursery (NICN).

"Birth-related neurological injury is the No. 1 cause of mental retardation and cerebral palsy in the United States," Rowitch says. "Our approach is to create focused research teams of scientists and clinicians to establish the root causes of neurological damage in infants and develop and test new therapies."

One key part is the world's first neuro ICU, designed as a state-of-the-art intensive care unit that integrates knowledge gleaned from basic science and is set up to host clinical trials for new therapeutics. The NICN will be fully connected to record extensive data about infants' vital statistics and their treatment. "Over time, bioinformatic analysis of this data may reveal patterns that provide unexpected new avenues for investigation," says Yao Sun, M.D., Ph.D, director of Clinical Programs in Neonatology at UCSF and an MIT-trained computer scientist.

"We have the clinical expertise to develop extensive monitoring systems, provide standard MRIs for low-birthweight babies and collect other measures of cerebral function," Rowitch says. "At the nursing level, we will look at the factors that go into things like limiting environmental stress."

At the same time that the NICN will be providing new clinical data, lab-based scientists in the NBRI will be studying basic scientific questions about the brain and its pathology, and suggesting novel drugs and new therapies that might be relevant for clinical trials.

One of the big advantages of this translational research system, Rowitch says, is that it should speed up the development and testing cycle for new neuroprotective therapies. "Right now, we have to wait as long as six to eight years (school age) to see if a neuroprotective therapy works," he says. "With better understanding of normal and perturbed brain development, using enhanced neuro-imaging and monitoring protocols, we should be able to tell more quickly if a therapy is having the desired effect.

"The new paradigms we are developing will be able to monitor kids in a much more extensive way than anywhere else in the country," Rowitch says. "This will make UCSF the go-to place for trials of new neuroprotective therapeutics."

Rowitch says he was attracted to UCSF in part because of its history in pioneering neonatal care and intensive care. In the 1960s at UCSF, William Tooley, M.D., created one of the nation's first neonatal ICUs, and the University played a critical role in developing methods for neonatal resuscitation, infant ventilation, and the identification and testing of artificial surfactant. The distinguished faculty currently at UCSF were also a draw for Rowitch.

The key to the whole enterprise will be the integration of basic and clinical sciences, Rowitch says. "We need to get scientists and clinicians talking to each other, and we hope to create a program of translational research at UCSF that will accomplish this goal. Even more important is to offer patients and their families real therapeutic options when faced with neurological injuries."

For more information, contact Dr. Rowitch at (415) 476-7242.

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