Jean & George Brumley, Jr. Neonatal-Perinatal Research Institute (NPRI)
In the United States, over 250,000 low birth weight infants are born each year. These infants often have a constellation of problems that affect their successful adaptation to extra-uterine life, which results in both acute and chronic problems that often exist beyond infancy. In North Carolina, low birth weight rates have risen from 7% to 9% in the past 10 years; and 2004, the state had the fifth highest infant death rate, falling just behind Louisiana, Mississippi, South Carolina and Wyoming.
The impact of infant morbidity extends far beyond the hospital delivery rooms and nurseries, and into society at large. For the afflicted child, a serious neonatal/perinatal problem can result in life-long physical and psychological suffering. This human tragedy, coupled with an economic burden exceeding $2 billion per annum, demand that effective solutions be found as quickly as possible. Unfortunately, although advances in the intensive care of the prematurely born have increased survival, the incidence of severe developmental delay has not improved. New insights into the etiology of premature labor and brain injury suggest that the initiating events of neural damage may precede the onset of premature labor and involve a complex sequence of events including inflammatory mediators, genetic predisposition, host response, and even social factors.
But what begins as a very parochial concern for the NPRI takes on a more global scientific meaning when one considers that as a result of fetal weight gain or loss or exposure to chemicals and toxins in utero and during the neonatal period, imprinting for adult diseases such as hypertension, diabetes, brain injury, arteriosclerosis, cardiac hypertrophy and asthma may be initiated. With more and more scientific data strengthening these associations, investigators using adult models of disease should consider potentially more relevant fetal and neonatal models to define adult disease and explore preventative and therapeutic options.
It was within this complex framework of disease that the Neonatal-Perinatal Research Institute (NPRI) was created to facilitate multidisciplinary basic and translational research aimed at understanding the basis of key problems suffered by neonates and to train the next generation of physician-scientists. Co-founded in 1997 by Dr. George Brumley, past Division Chief of the Duke Neonatal-Perinatal Program and Professor and Chairman Emeritus, Emory School of Medicine and Dr. Ronald Goldberg, present Division Chief of the Duke Neonatal-Perinatal Program, the NPRI has grown from concept stage to a successful, multi-million dollar environment for serious multidisciplinary research. The NPRI presently hosts 82 faculty, in the following areas of investigation: 1) developmental biology with emphasis on neurodevelopmental and cardio/cranio/facial developmental biology; 2) neurological injury and repair in the fetus and neonate; 3) neonatal lung development /injury and repair; 4) clinical neonatal research in conjunction with the NICHD Neonatal Network and the Duke Clinical Research Institute; and 5) promotion of translational research with the Pratt School of Engineering. In addition, the NPRI supports unique programs for the study of health care policy, medical informatics, and health care finances all within the context of medical research and fellowship training.
The NPRI supports and funds a wide range of basic science research initiatives. Basic researchers from Cell Biology, Neurobiology, Immunology, and Pharmacology collaborate with their colleagues in Cardiology, Neonatology, Neurology, Pediatrics, Anesthesiology, and Critical Care to elucidate fundamental mechanisms underlying congenital neural tube disorders, congenital cardiac defects, and neonatal brain injury.
In addition to these basic research initiatives, the NPRI has been successful in bridging the gap between ‘bench to bed’ research. NPRI researchers are members of the NICHD-funded multi-site Neonatal Research Network. NPRI-sponsored research won the first Duke Translational Medicine Award for its research to bring a novel pulmonary vasodilator and antinflammatory agent to the bedside. In 2006, engineering students, working in collaboration with NPRI researchers, developed a new phototherapy device which won the $100,000 Duke University Engineering World Health CURE(s) competition. Together with the Pratt School of Engineering, the NPRI conducts ground breaking research in digital microfluidics, inexpensive photherapy devices for third world countries, design of virtual simulation environments for clinical training, and the development of non-invasive analyte detection methodologies.
The decision to support studies in Health Care Policy, Medical Informatics, Health Care Finance and Education through the NPRI reflects the program’s mission to train the next generation of physician-scientists in the responsible and ethical use of scarce health care resources. NPRI researchers have been successful in providing new tools and strategies to improve institutional processes involved with health care organizations resulting in the recovery of millions of health care dollars.