Neonatology Chief Focuses on Spectrum of Infant Care

Infant Brain Development 

Neonatology Chief Focuses on Spectrum of Infant Care, Brain Development and Environmental Exposures

Whether she’s in the University of Maryland Children’s Hospital’s neonatal intensive care unit (NICU) or in the lab, Cynthia Bearer, M.D., Ph.D.’s work has a single focus: excellent outcomes for babies.

The tiniest and sickest infants come to the 40-bed Level IV NICU, which not only treats extreme prematurity and its many complications but follows NICU “graduates” for three years after discharge, offering assessments and support for unresolved problems. Dr. Bearer, the Mary Gray Cobey Professor of Neonatology and chief of the Division of Neonatology at University of Maryland School of Medicine, also tackles complex research topics — mainly relating to how chemicals affect the developing brain — as a way of marrying her NICU work with optimizing these and other infants’ growth.

Specialized care for critical issues

A typical scenario in the NICU, she says, involves a baby whose birth defect has been discovered in utero through a routine ultrasound. The pregnant mother is referred to the University of Maryland Medical Center’s Advanced Fetal Care and followed by doctors for the remainder of the pregnancy, during which she and her partner are familiarized with staff neonatologists and the NICU surroundings. A team from the NICU then attends the birth and stabilizes the baby. Physicians from many specialties will then provide care for the baby.

“One of the things that really sets our NICU apart is the way our nursing staff operates,” Dr. Bearer explains, noting that specialized rooms are available for very low — and extremely low — birth weight babies, for those needing surgical intervention and an emerging unit to deal specifically with cardiothoracic problems. “We have an outstanding cardiothoracic surgeon who is NIH-supported in using cardiac stem cells to improve outcomes in babies with congenital heart disease.”

Specialized treatments often employed in the NICU include peritoneal dialysis, ECMO, body cooling, nitric oxide therapy and post-operative care for complex neonatal surgeries involving many organ systems.

Research pairs environment and health

Much of Dr. Bearer’s research focuses on the developing brain and how certain chemicals can disrupt its development by affecting lipid rafts, the molecular platforms on the cell’s outer membrane that control what enters and exits cells and how they send and receive signals. With 7 million Americans afflicted with mental retardation and 17% of children under 18 coping with at least one developmental disability, she considers environmental exposures a huge part of how each child’s development progresses.

“I do this because of my love for the environment and my concern that pollutants are having an effect on human health,” Dr. Bearer says. “We have found that supplementation with certain nutrients (particularly choline) prevents these effects.”

Chemicals she’s currently researching include:

  • Ethanol, the alcohol in liquor as well as hand sanitizers and gasoline;
  • Toluene, a solvent present in water, common household products, and automobile exhaust;
  • Volatile organic chemicals (VOCs) from disinfectants, glues and plastics;
  • Chlorhexidine, a widely used broad-spectrum antimicrobial;
  • Benzyl alcohol and propylene glycol, two chemicals used to solubilize medications so they can be administered by vein; and
  • Bilirubin, the breakdown product of hemoglobin that causes newborn jaundice.
  • Volatile anesthetics, a type of general anesthetic used for complex surgeries.

Ethanol is a proven neurotoxicant, disrupting the way proteins interact with the cell membrane, Dr. Bearer notes, so these other solvents may share a common mechanism. Similarly, bilirubin isn’t water soluble, so it accumulates in cell membranes. In her lab, she is determining a way to measure neurite outgrowth — the development of connections between neurons — and “when these cues are turning on and off.”

Blood transfusions scrutinized

Even in the NICU itself, there may be environmental exposures that could ultimately be detrimental to these vulnerable babies. Dr. Bearer is investigating the amount of lead, mercury and cadmium premature infants are exposed to through blood transfusions — levels that might not harm older, healthier patients — to determine whether these heavy metals impact their development.

“I got 35 samples from our blood bank ... and found that lead concentrations are declining, as they are in general because of the removal of lead from gasoline,” she says. “But mercury concentrations were higher in Maryland, I think because Baltimore folks eat more seafood. So now I’m doing a study to see if this exposure affects how well our premature infants do.”

Ways to cut down on blood transfusions to NICU infants are also being investigated, including procedures and instruments that don’t require drawing blood to determine things like bilirubin levels, for example.

“Skin sensors are being developed here in our NICU to measure levels (of substances) in blood without actually taking blood, like doing a skin wipe,” Dr. Bearer says. “Another way is where we take blood out, measure what we have to by shooting a beam of light through it, and re-infusing the blood. We’re talking about doing that for our extremely tiny babies.”

For more information or to have a baby transferred to the University of Maryland Children’s Hospital, please contact OneCall at 1-800-373-4111.

This page was last updated: November 7, 2013

         
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