Neonatal Research Network Highlights

The NRN has published over 300 manuscripts in peer-reviewed journals including the New England Journal of Medicine and Journal of the American Medical Association. The results of the following trials conducted by the NRN led to major changes in newborn care:

  1. Neonatal inhaled Nitric Oxide (NINOS) Trial (1992): Nitric oxide helps dilate blood vessels and improves oxygenation, significantly reducing the use of extracorporeal membrane oxygenation (ECMO) in infants with hypoxic respiratory failure and pulmonary hypertension. Drs. Van Meurs and William Rhine proposed this trial to the Network, and Stanford was a top recruiter to this trial that was one of two large randomized controlled trials leading to the FDA approval of nitric oxide for this indication. 
  2. Whole Body Hypothermia trial (1999): This was the first randomized clinical trial to find that treatment of newborns with moderate to severe hypoxic ischemic encephalopathy (HIE) with whole body hypothermia before 6 hours of age results significantly reduced rates of death or neurodevelopmental impairment at 18-22 months of age. Therapeutic cooling is now standard of care for newborns ≥ 36 weeks gestation with moderate to severe HIE.
  3. Vitamin A (1999): Among Extremely Low Birth Weight (ELBW) infants, vitamin A supplementation during the first month of life reduced the risk of bronchopulmonary dysplasia.
  4. Extremely Low Birth Weight Phototherapy trial (2005): Among extremely low birth weight (ELBW) infants, aggressive treatment with phototherapy reduced the combined outcome of death or neurodevelopmental impairment and most other morbidities. However, among infants with birth weights 501-750 grams, the reduction in neurodevelopmental impairment may be offset by an increase in mortality.
  5. SUPPORT study (2010): In extremely preterm infants, early management with CPAP did not result in increased risk for death or Bronchopulmonary Dysplasia (BPD) compared with intubation and early surfactant. In secondary analyses, the CPAP strategy resulted in a reduced rate of postnatal corticosteroid use, and a shorter duration of ventilation compared with intubation and early surfactant. This study supported consideration of CPAP as an alternative to routine intubation and surfactant. The SUPPORT study also demonstrated the importance of careful management of oxygen saturation. The range of oxygen saturation ranges commonly used in NICUs around the world was bisected and infants were randomly assigned to the higher/lower ranges to determine the range with less risk for the combined outcome of ROP or death. The trial results found that the lower target range of saturation did not significantly decrease the composite outcome of severe ROP or death. However, it did find an increase in mortality and a substantial decrease in severe ROP among survivors who randomized to the lower saturation target range. The information gained from this trial has significantly influenced current NICU practice around the world.

A complete bibliography of Network manuscripts is available here