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Vol. LXVII, No. 2
January 16, 2015
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Improving Outcomes for High-Risk Infants
NINR Director’s Lecture Traces Advancement of Neonatal Care

Dr. Barbara Medoff-Cooper, who is now the Ruth M. Colket professor in pediatric nursing at the University of Pennsylvania School of Nursing, saw some of the first 1,000-gram infants to be born “intact” during the early days of her career as a pediatric nurse practitioner at Children’s Hospital of Philadelphia. Their struggle to survive and the struggle of their parents to learn how to care for such fragile newborns inspired her move to research.

At a recent NINR Director’s Lecture, “Innovations in High-Risk Infant Care: Creating New Pathways,” Medoff-Cooper traced the highlights of a career dedicated to discovering the connections between infant feeding behavior, weight gain and neurodevelopment. She also described key collaborations with colleagues in engineering, psychology, cardiology, pediatrics and other disciplines that led to the development of groundbreaking new research technologies and family-centered interventions.

NINR director Dr. Patricia Grady (l) greets presenter Dr. Barbara Medoff-Cooper at the NINR Director’s Lecture. “Through her leadership in nursing science, Dr. Medoff-Cooper has advanced the field of neonatal care,” said Grady. “She has shown tenacity and ingenuity in her effort to build the evidence base linking early feeding behavior to health outcomes for this most vulnerable of populations. Her work gives us an inspirational glimpse of the future, in which mHealth, personalized interventions and self-management in settings other than the hospital will be the gold standard of health care.”

NINR director Dr. Patricia Grady (l) greets presenter Dr. Barbara Medoff-Cooper at the NINR Director’s Lecture. “Through her leadership in nursing science, Dr. Medoff-Cooper has advanced the field of neonatal care,” said Grady. “She has shown tenacity and ingenuity in her effort to build the evidence base linking early feeding behavior to health outcomes for this most vulnerable of populations. Her work gives us an inspirational glimpse of the future, in which mHealth, personalized interventions and self-management in settings other than the hospital will be the gold standard of health care.”

Noting “there were no MRIs in those days,” Medoff-Cooper described how her early experience with nuclear magnetic resonance spectroscopy to study “brain metabolism” in infants with grade 3-4 bleeds led to her hypothesis that feeding behaviors might be seen as an index of neurobehavioral integrity, the topic of her first NINR R01. Her lab became the first to identify the microstructure of nutritive sucking across gestational ages as an indicator of the maturational process.

In later studies, by helping develop ever more sophisticated versions of a nutritive sucking device used to assess feeding behavior (now known as the Neonur) and behavioral measures such as the Early Infancy Temperament Questionnaire, Medoff-Cooper was able to demonstrate that early feeding organization is indeed a significant predictor of developmental outcomes at 12 months.

After these successes, she shifted her focus to a different population: infants born with complex congenital heart defects (CHD). Like medically fragile premature infants, newborns with CHD also have poor feeding behaviors that are linked to poor nutritional intake and weight gain, developmental delays and high parental stress. In addition, these infants are more likely to die between their first cardiac surgery and 4-5 months of age.

Her current study is a randomized controlled trial comparing the health outcomes and cost of care of a telehealth home monitoring intervention to standard post-discharge care. Named REACH, it addresses not only the CHD infants, but also their parents. “We felt strongly that this belonged to nursing, that we needed to think about ways to help these parents deal with the enormous challenge of constant feeding, cleaning of tubes and watching for breathing difficulties in their infants post discharge,” Medoff-Cooper said.

Parents in the REACH intervention group receive daily text messages and virtual home visits from an advance pediatric nurse twice a week via Skype or FaceTime. They can also text questions or post videos at any time about changes in their infant’s status and receive a timely response that determines whether emergency care is needed. Infants are followed for 4 months or until their second surgery.

Medoff-Cooper expressed her belief that REACH should be state-of-the-art care for every infant leaving the cardiac intensive care unit. “The combination of technology and a comprehensive approach to family-centered support has advanced neonatal care and enables these families to grow to their full potential,” she said.

To view the full lecture, visit https://www.youtube.com/watch?v=33-0mnebT2Y. The next NINR Director’s Lecture will be held on Tuesday, Mar. 3. For more information, visit www.ninr.nih.gov/directorslecture.


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