In May 2009, neonatologists, pediatric neurologists and other specialists at Johns Hopkins put into action a concept implemented by only a handful of children’s hospitals across the country—a formal neuro-neonatal medicine program. What would become the Neurosciences Intensive Care Nursery (NICN) would not only function as a multidisciplinary consultative clinical service designed to minimize brain injury in neonates, but also an ongoing learning environment for the care team and a rich source of research initiatives. In May 2019, the NICN reached a milestone.
“We’re 10 years old today, and it has been a marvelous, marvelous, marvelous experience,” noted neonatologist Frances Northington, co-director of the NICN, addressing national leaders in neuro-neonatal care at the kick-off of a May 30-31 symposium marking the occasion. “So many collaborations and clinical programs have come out of the NICN. Now our mission is to inspire you to continue doing what you’re doing so these babies can have better lives.”
“The NICN is no longer a baby,” added Tina Cheng, co-director of Johns Hopkins Children’s Center. “It’s going through early adolescence, figuring out its identity and where it’s going to go in the future.”
Looking back to even before NICN’s creation, Northington cited the work of colleagues such as then Johns Hopkins pediatric neurologist Rebecca Ichord. Much has changed, Northington added, fast-forwarding to lessons learned at the NICN symposium. Among them were that neuropathology mechanisms hold promise for nonsurgical treatment of hydrocephalus, and new types of data will better predict which babies will respond best to hypothermia treatment for hypoxia brain injury. The symposium also addressed both the diagnostic and therapeutic value of the newborn neurologic exam, and the indications and implications of various neonatal screening for newborn brain disease.
“We’ve learned that one biomarker may perform better than all those traditional measures,” said Northington. “Just imagine what we’ll learn when we have a panel of biomarkers?”
Symposium presentations covered a potpourri of neonatal-neuro issues, including a neurologist’s perspective on newborn assessment by pediatric neurologist Carl Stafstrom, post-hemorrhagic hydrocephalus of prematurity by pediatric neurosurgeon Shenandoah Robinson, novel placental mediated mechanisms of perinatal brain injury by researcher Lauren Jantzie, and genetic screening for neurologic diseases in infancy by geneticist Hilary Vernon. Neonatologist Raul Chavez Valdez covered potential mechanisms underlying learning and memory disturbances, and neonatologist Marilee Allen and neurodevelopmental pediatrician Joanna Burton made a presentation about personalized early intervention strategies supporting neuromaturation. Anesthesiologist and critical care specialist Jennifer Lee-Summers spoke about reducing white matter injury in neonatal hypoxic ischemic encephalopathy, and neonatologist Maureen Gilmore addressed neuroprotection in the neonate.
Keynote talks included “Protecting the newborn brain: We Need Cocktails and Ice,” by pediatric neurologist Donna Ferriero of the University of California, San Francisco, and “The Human Brain: The Undiscovered Realm for Neuro-Therapeutics” by Johns Hopkins neuropathologist Lee Martin.
Northington cited the foundational work, especially in the role of plasticity of the brain in recovery, of pediatric neurologist Michael Johnston, director of the neuroscience laboratory at Kennedy Krieger Institute. She also pointed to feedback from a panel of parents eager for more communication from the NICN team, saying, “They want information from us rather than Dr. Google, and they want this information sooner that we have traditionally been taught.”
Northington had a take-home message: “The underpinnings of our talks over the two days is what we’re all about — collaboration.”
She concluded, “One final word, never forget, it’s all about the babies.”