Heather H. Burris, MD, MPH, is a neonatologist at Children’s Hospital of Philadelphia (CHOP) and Associate Professor of Pediatrics at the University of Pennsylvania’s Perelman School of Medicine. Her work probes the social and environmental drivers of perinatal health inequities and tests interventions that could transform outcomes for mothers and infants alike. In this conversation, Dr. Burris reflects on her research portfolio — from large-scale cohorts to randomized controlled trials — and the implications for practice across neonatology and maternal health.
Q: You’ve described yourself as a “neonatologist driven by environmental injustice that perpetuates perinatal health disparities.” What led you down that path?
Dr. Burris: I grew up the daughter of a neonatologist and a nurse, but for a long time I resisted following in their footsteps. Eventually, I realized medicine combined my love of science and my care for people.
Once in neonatology training, I couldn’t ignore what I was seeing: stark disparities. Black women in the U.S. have a 50% higher risk of preterm birth and triple the risk of extreme preterm birth. Those inequities aren’t explained by biology, they’re rooted in structural and environmental injustice.
That means we have to study not only the infants in front of us in the NICU but also the social and environmental conditions that brought them here. My research ranges from population-level epidemiology to targeted interventions within hospital walls.
Q: One of your most talked-about projects is the PeliCaN trial. How did it come about?
Dr. Burris: The idea came from a moment on rounds. I noticed a mother sitting by her critically ill baby. She looked unwell herself. It turned out she had a post-cesarean infection. That experience crystallized the problem: mothers of NICU babies often sacrifice their own health for their child’s. We designed the PeliCaN model — PeliCaN standing for Postpartum Care in the NICU — to bring midwives and doulas directly into that space.
Q: How was the study designed, and what were the key findings?
Dr. Burris: PeliCaN was a single-center randomized controlled trial conducted at the Hospital of the University of Pennsylvania, staffed by CHOP neonatologists. We enrolled 37 postpartum mothers whose infants were born before 34 weeks’ gestation and anticipated to remain in the NICU for at least one week.
Half received standard care. The intervention arm embedded doulas and certified nurse midwives in the NICU, offering both in-person and telehealth follow-up. Outcomes included timing of postpartum visits and completion of three evidence-based care components: blood pressure checks, depression screening and contraceptive counseling.
The results were striking. Mothers in the intervention group had their first postpartum visit an average of 11 days after discharge, compared with 31 days in the control group. Nearly all mothers in PeliCaN received the full set of care components; six women in the usual care group missed at least one, including four who never had blood pressure measured. That’s clinically significant given the risk of hypertensive disorders in this population.
Q: What did mothers tell you mattered most about that support?
Dr. Burris: The care itself was essential, but the human connection was transformative. Many women feel invisible once the baby is born — what one colleague calls the “candy wrapper” effect. The baby is the candy, and the mother becomes the wrapper, overlooked once it has served its purpose.
Doulas flipped that script. They sat with mothers, validated their experiences, sometimes even walked with them to get a cup of tea. That may sound small, but when mothers feel valued, they’re more likely to absorb information about their baby’s care and to take steps to protect their own health. In turn, that strengthens the family unit, something every NICU team wants.
Q: What are the implications for neonatology and perinatal care?
Dr. Burris: Neonatologists are uniquely positioned to influence maternal health outcomes. When a baby is in the NICU, the mother is tethered to that unit. If we integrate maternal care supports into that environment, we reduce the likelihood of missed or delayed postpartum care — something that contributes to preventable morbidity and mortality.
For neonatology, this shifts the frame: we’re not only optimizing outcomes for fragile infants, but also protecting the long-term health of their mothers. That dual focus can help break intergenerational cycles of poor health.
Q: You also lead large-scale observational studies like Penn-CHOP ECHO and GeoBirth. How do these complement intervention work like PeliCaN?
Dr. Burris: They’re deeply connected. ECHO, the NIH-funded Environmental influences on Child Health Outcomes program, is following families longitudinally to understand how prenatal and early-life exposures — air quality, neighborhood stressors, social determinants — shape child health. At our Penn-CHOP site, we’re enrolling 2,500 pregnant individuals and linking to their infants’ outcomes.
GeoBirth is a birth cohort that rigorously phenotypes preterm births and links them to neighborhood-level data. That allows us to ask, for example, whether greenspace reduces preterm birth risk or whether neighborhood disinvestment increases it.
Those studies tell us where inequities are coming from. Intervention studies like PeliCaN test how we can begin to close them.
Q: What do you see as the biggest gap in the current evidence base?
Dr. Burris: We have abundant data describing disparities but fewer rigorously tested solutions. Maternal health interventions often stop at delivery, leaving a critical gap in the postpartum period. For mothers of NICU infants, that gap is even more dangerous.
The field needs more pragmatic trials — like PeliCaN — that test scalable models within real-world hospital settings. We also need implementation science to understand what it takes to embed these models sustainably across health systems.
Q: Where does the work go from here?
Dr. Burris: We’re preparing to expand PeliCaN into a multi-site study across the CHOP Newborn Care Network. That will allow us to test scalability, sustainability and generalizability.
At the same time, my team continues to leverage ECHO and GeoBirth to generate the upstream evidence base. For example, we’re studying greenspace exposure and pregnancy outcomes with Dr. Eugenia South, work that could inform urban planning as a public health intervention.
Ultimately, the goal is a continuum: rigorous epidemiology to define the problem, interventions to address it, and systems change to sustain progress.
Q: You balance a demanding research agenda with clinical care and mentorship. How do you view your role in the broader field?
Dr. Burris: Neonatology has always been about pushing boundaries — ventilation strategies, surfactant, neuroprotection. The next frontier is equity. We cannot call our care excellent if it’s only excellent for some families.
I see my role as both investigator and mentor. My mentees may take this work in directions I can’t even imagine today. If we train the next generation to see equity as core to excellence, then CHOP’s impact extends far beyond Philadelphia.
By embedding maternal supports in the NICU and uncovering the social and environmental drivers of inequity, Dr. Burris and her colleagues are positioning CHOP at the forefront of a new era in neonatal-perinatal medicine — one in which maternal and infant health are inseparable, and equity is treated as essential to quality.
Heather H. Burris, MD, MPH, is a neonatologist at Children’s Hospital of Philadelphia (CHOP) and Associate Professor of Pediatrics at the University of Pennsylvania’s Perelman School of Medicine. Her work probes the social and environmental drivers of perinatal health inequities and tests interventions that could transform outcomes for mothers and infants alike. In this conversation, Dr. Burris reflects on her research portfolio — from large-scale cohorts to randomized controlled trials — and the implications for practice across neonatology and maternal health.
Q: You’ve described yourself as a “neonatologist driven by environmental injustice that perpetuates perinatal health disparities.” What led you down that path?
Dr. Burris: I grew up the daughter of a neonatologist and a nurse, but for a long time I resisted following in their footsteps. Eventually, I realized medicine combined my love of science and my care for people.
Once in neonatology training, I couldn’t ignore what I was seeing: stark disparities. Black women in the U.S. have a 50% higher risk of preterm birth and triple the risk of extreme preterm birth. Those inequities aren’t explained by biology, they’re rooted in structural and environmental injustice.
That means we have to study not only the infants in front of us in the NICU but also the social and environmental conditions that brought them here. My research ranges from population-level epidemiology to targeted interventions within hospital walls.
Q: One of your most talked-about projects is the PeliCaN trial. How did it come about?
Dr. Burris: The idea came from a moment on rounds. I noticed a mother sitting by her critically ill baby. She looked unwell herself. It turned out she had a post-cesarean infection. That experience crystallized the problem: mothers of NICU babies often sacrifice their own health for their child’s. We designed the PeliCaN model — PeliCaN standing for Postpartum Care in the NICU — to bring midwives and doulas directly into that space.
Q: How was the study designed, and what were the key findings?
Dr. Burris: PeliCaN was a single-center randomized controlled trial conducted at the Hospital of the University of Pennsylvania, staffed by CHOP neonatologists. We enrolled 37 postpartum mothers whose infants were born before 34 weeks’ gestation and anticipated to remain in the NICU for at least one week.
Half received standard care. The intervention arm embedded doulas and certified nurse midwives in the NICU, offering both in-person and telehealth follow-up. Outcomes included timing of postpartum visits and completion of three evidence-based care components: blood pressure checks, depression screening and contraceptive counseling.
The results were striking. Mothers in the intervention group had their first postpartum visit an average of 11 days after discharge, compared with 31 days in the control group. Nearly all mothers in PeliCaN received the full set of care components; six women in the usual care group missed at least one, including four who never had blood pressure measured. That’s clinically significant given the risk of hypertensive disorders in this population.
Q: What did mothers tell you mattered most about that support?
Dr. Burris: The care itself was essential, but the human connection was transformative. Many women feel invisible once the baby is born — what one colleague calls the “candy wrapper” effect. The baby is the candy, and the mother becomes the wrapper, overlooked once it has served its purpose.
Doulas flipped that script. They sat with mothers, validated their experiences, sometimes even walked with them to get a cup of tea. That may sound small, but when mothers feel valued, they’re more likely to absorb information about their baby’s care and to take steps to protect their own health. In turn, that strengthens the family unit, something every NICU team wants.
Q: What are the implications for neonatology and perinatal care?
Dr. Burris: Neonatologists are uniquely positioned to influence maternal health outcomes. When a baby is in the NICU, the mother is tethered to that unit. If we integrate maternal care supports into that environment, we reduce the likelihood of missed or delayed postpartum care — something that contributes to preventable morbidity and mortality.
For neonatology, this shifts the frame: we’re not only optimizing outcomes for fragile infants, but also protecting the long-term health of their mothers. That dual focus can help break intergenerational cycles of poor health.
Q: You also lead large-scale observational studies like Penn-CHOP ECHO and GeoBirth. How do these complement intervention work like PeliCaN?
Dr. Burris: They’re deeply connected. ECHO, the NIH-funded Environmental influences on Child Health Outcomes program, is following families longitudinally to understand how prenatal and early-life exposures — air quality, neighborhood stressors, social determinants — shape child health. At our Penn-CHOP site, we’re enrolling 2,500 pregnant individuals and linking to their infants’ outcomes.
GeoBirth is a birth cohort that rigorously phenotypes preterm births and links them to neighborhood-level data. That allows us to ask, for example, whether greenspace reduces preterm birth risk or whether neighborhood disinvestment increases it.
Those studies tell us where inequities are coming from. Intervention studies like PeliCaN test how we can begin to close them.
Q: What do you see as the biggest gap in the current evidence base?
Dr. Burris: We have abundant data describing disparities but fewer rigorously tested solutions. Maternal health interventions often stop at delivery, leaving a critical gap in the postpartum period. For mothers of NICU infants, that gap is even more dangerous.
The field needs more pragmatic trials — like PeliCaN — that test scalable models within real-world hospital settings. We also need implementation science to understand what it takes to embed these models sustainably across health systems.
Q: Where does the work go from here?
Dr. Burris: We’re preparing to expand PeliCaN into a multi-site study across the CHOP Newborn Care Network. That will allow us to test scalability, sustainability and generalizability.
At the same time, my team continues to leverage ECHO and GeoBirth to generate the upstream evidence base. For example, we’re studying greenspace exposure and pregnancy outcomes with Dr. Eugenia South, work that could inform urban planning as a public health intervention.
Ultimately, the goal is a continuum: rigorous epidemiology to define the problem, interventions to address it, and systems change to sustain progress.
Q: You balance a demanding research agenda with clinical care and mentorship. How do you view your role in the broader field?
Dr. Burris: Neonatology has always been about pushing boundaries — ventilation strategies, surfactant, neuroprotection. The next frontier is equity. We cannot call our care excellent if it’s only excellent for some families.
I see my role as both investigator and mentor. My mentees may take this work in directions I can’t even imagine today. If we train the next generation to see equity as core to excellence, then CHOP’s impact extends far beyond Philadelphia.
By embedding maternal supports in the NICU and uncovering the social and environmental drivers of inequity, Dr. Burris and her colleagues are positioning CHOP at the forefront of a new era in neonatal-perinatal medicine — one in which maternal and infant health are inseparable, and equity is treated as essential to quality.