Published onNeonatology Update
Neonatal resuscitation is a high acuity, low occurrence event. Limited high-quality evidence informs neonatal resuscitation treatment recommendations. CHOP Attending Neonatologist Elizabeth Foglia, MD, MA, MSCE, seeks to change that. She leads a team of researchers at CHOP who seek to identify the best methods to monitor and perform neonatal resuscitation, with the ultimate goal of optimizing clinical outcomes for high-risk infants.
Here, she discusses the why behind their research, and why it has her excited!
Q: What is your current role at CHOP?
A: I’m an Attending Neonatologist at Children’s Hospital of Philadelphia and the Director of Neonatal Resuscitation and Simulation at the Hospital of the University of Pennsylvania. I serve on the Steering Committee for the American Academy of Pediatrics Neonatal Resuscitation Program. I am also a member of the Neonatal Life Support Taskforce for the International Liaison Committee on Resuscitation (ILCOR), which formulates the guidelines for neonatal resuscitation used globally.
Q: What is the focus of your research?
A: I perform clinical research related to neonatal resuscitation and respiratory management. My research aims to characterize the epidemiology of neonatal resuscitation, to improve monitoring and clinical performance during resuscitation, and to identify interventions to prevent mortality and long-term morbidity in high-risk infants.
Q: What current research projects are you most excited about?
A: There are two: The first is the Delivery Room Intervention and Evaluation (DRIVE) Network. This is an initiative convened by the American Academy of Pediatrics (AAP). It’s the first network of delivery hospitals designed specifically to study and improve neonatal resuscitation across an inclusive and diverse population of infants.
CHOP serves as the DRIVE Data Coordinating Center (DCC). Six academic centers with their associated Level I and II neonatal intensive care units are the other members. They include the University of Pennsylvania; University of Texas, Southwestern; Columbia University; University of Oklahoma; Saint Louis University; and Stanford University. Together, the hospitals represent over 50,000 births per year.
The delivery room is a unique setting. Immediately after birth, all newborns must rapidly undergo many complex physiologic transitions to successfully adapt to the extrauterine environment.
Beyond limited research settings, little is known about the incidence, quality and outcomes of neonatal resuscitation in diverse clinical locations in the U.S. Most multicenter neonatal registries specialize in high-risk populations such as preterm infants or infants admitted to the neonatal intensive care unit (NICU). Currently, no infrastructure exists to study and improve provider performance and clinical outcomes for an inclusive population of infants who receive delivery room resuscitation.
Our goal with DRIVE is to innovate healthcare delivery by designing and testing solutions to improve provider training, team performance, and clinical outcomes for newborns who require resuscitation at birth. We are currently in the first project phase, which involves collecting and analyzing clinical data from all DRIVE sites.
Collecting clinical data is time-intensive for all sites. To address this and increase efficiency, we are investing in an informatics-based approach to data collection that leverages the electronic medical record. Two members of our team — CHOP Neonatologist Leah Carr, MD, and Data Integration Analyst Paul Wildenhain — have developed novel methods of embedding resuscitation data capture within clinical documentation in EPIC and extracting the data for automated submission to DRIVE. Using this process, monthly data collection for each site will take minutes instead of hours. We are really excited about what this approach will mean for future growth of the DRIVE Network.
The other project that most excites me is an effort at CHOP focused on the “golden hour” for infants born with congenital anomalies. The golden hour represents the time immediately after birth when a series of complex physiologic changes occur. Optimal golden hour care is associated with improved outcome for other high-risk populations, like preterm infants.
Newborns with congenital anomalies confront significant challenges during the transition to the extrauterine environment, leading to the need for delivery room resuscitation. However, existing resuscitation algorithms do not address infants with congenital anomalies. Thus, care is currently expert based and not data driven, transitional physiology is undefined, and best practices are often unknown. This is a major limitation to care.
We are home to the Richard D. Wood Jr. Center for Fetal Diagnosis and Treatment (CFDT), the largest center worldwide dedicated to babies with congenital anomalies, and the Garbose Family Special Delivery Unit (SDU), the world’s first birthplace for babies with anomalies within a children’s hospital. We care for the largest volume of babies with a wide range of congenital birth defects. Immediate stabilization and resuscitation of these patients after birth is performed by a core team of neonatologists and neonatal providers. This makes us uniquely positioned to define and improve optimal “golden hour” management for this population.
In 2019, we conducted the first neonatal delivery room clinical trial in the SDU and demonstrated that a novel approach of initiating resuscitation prior to umbilical cord clamping for infants with congenital diaphragmatic hernia is safe, feasible, and well accepted by mothers. Importantly, this study established essential organization and infrastructure to support neonatal resuscitation research at CHOP.
We recently received a significant investment from CHOP to further expand our research and clinical program for neonatal resuscitation in the Special Delivery Unit as part of a “Frontier Program.” My collaborators for this Frontier Program include fellow CHOP Attending Neonatologists Anne Ades, MD, and Natalie Rintoul, MD, and the CFDT Business Manager Tom Reynolds, MBA. Our objective is to generate the data needed for evidence-based guidelines for resuscitation of newborns with congenital anomalies. In addition, we have developed a prototype digital tool to provide clinicians the information they need to perform complex resuscitations in the SDU. One goal of our program is to refine this tool to become an interactive and integrated digital platform to drive resuscitation team performance and improve outcomes of babies born with congenital anomalies. This tool will allow us to deliver unparalleled individualized care to our complex patients during resuscitation immediately after birth.
Both of these projects are exciting opportunities. We are focused on generating the best possible evidence to improve the care we deliver immediately after birth locally and to advance the field of neonatal resuscitation science globally.