UVA’s Neonatal Intensive Care Unit (NICU) cares for some of our smallest and medically complex patients. At the same time, neonatologists at UVA are leading a number of large, multicenter research collaborations with the goal of improving outcomes of premature infants from the delivery room through their discharge home and beyond. Karen Fairchild, MD, oversees some of these studies, funded by the National Institutes of Health (NIH).
*which have received nearly $5 million of National Institutes of Health (NIH) funding.
Q: What brought you to UVA?
Fairchild: I came to the University of Virginia in 2004 from the University of Maryland, and was recruited in part to continue my research on hypothermia, which is used as a treatment for patients with brain injury. At UVA, I was given a lab, time, and seed money, thanks to the UVA Children’s Hospital grants program and funding from the Department of Pediatrics and School of Medicine. Within a few years, I had some papers published on how hypothermia affects inflammation, and then in 2007 I received a five-year grant from the NIH.
In my lab, I developed models to study how hypothermia impacts the immune system’s response to infection. Adults get a fever when they have an infection—but babies, and some adults, with severe infection develop low body temperature, which can impair the body’s ability to fight infection. On the other hand, hypothermia can be neuroprotective.
Since 2005, we have been using therapeutic hypothermia in the UVA NICU for infants with acute brain injury around the time of birth. This is a great example of bench-to-bedside research—research that is able to leave the lab and directly improve patient care. The Neuro NICU at UVA is an important program that aims to improve outcomes of babies will all types of brain disorders and injuries.
Q: What kind of research have you done at UVA? What are you working on now?
Fairchild: Initially, I was doing mostly what is called “bench,” or basic science, research—molecular and cellular work that I then took a step further to preclinical animal models. In 2011, I made the transition from bench to clinical research, which was successful thanks to several great mentors and collaborators at UVA.
I currently have three NIH grants, focusing on sepsis, apnea, and delivery room resuscitation. My team is developing early warning systems for severe infection or sepsis, which is a major cause of death and disability in preterm infants. We analyze heart rate and breathing patterns and other variables to detect sepsis before a baby is obviously sick. By starting antibiotics sooner, we can improve patient outcomes.
Another project revolves around apnea and lung disease in preterm infants, which is a collaboration with five other NICUs around the country. And the third project is called “VentFirst,” and involves helping preterm infants breathe while they are attached by the umbilical cord to the placenta. My Co-Principal Investigator on this project, John Kattwinkel, MD, is an expert in neonatal resuscitation and has been a great mentor since I came to UVA. Together we are leading this 10-center study with the goal of decreasing bleeding in the brain of extremely preterm infants.
*It can actually be beneficial to delay the cutting of a premature baby’s umbilical cord until after birth, as it lowers the risk of bleeding in the brain and other complications. However, many very preterm babies do not breathe well on their own, so many obstetricians cut the cord early to allow the neonatology team to assist breathing.
My colleagues and I are also applying for funding from the UVA Brain Institute to study blood pressure patterns and brain injury in both full term and preterm infants, which we are working on in conjunction with the NICU team at Washington University in St. Louis. We’re hoping that, with some start-up funding for a pilot study, we can get an NIH grant to discover biomarkers or tests that can identify babies with brain injury that might benefit from certain medications or other therapies.
Q: How important are seed grants and private philanthropic funding when it comes to starting research projects?
Fairchild: Extremely important. I was in charge of grants program until a few years ago, and we gave anywhere from $5,000 to $50,000 to support the research of new investigators and trainees. The idea is that with start-up internal funding, their projects would eventually attract outside funding.
The return on investment can be huge. A $50,000 grant for a pilot project can lead $5,000,000 NIH grant. We’ve seen that happen.
I don’t think I’d have gotten NIH funding without some of the initial seed funding and private philanthropic support I received at UVA. Funding from UVA helped to support the VentFirst pilot study, and allowed us to collect data on feasibility and safety of the intervention, which led to a multicenter clinical trial.
Q: What’s the importance of collaborations across the Health System and the University?
Fairchild: Collaborations are key—you cannot thrive or survive without them. You cannot survive in the competitive world of biomedical research if you work in a silo. I work with researchers in cardiology, engineering, math and statistics, the School of Nursing, and the Data Science Institute, among others. Big data analytics is a key aspect of our research, and as a clinician first and foremost, I do not have the skillsets required to do these analyses.
External collaborations beyond UVA are also crucial. Although we have more than 600 babies per year that we care for in the UVA NICU, that’s not enough to answer important research questions—especially when you consider that we have to get permission from parents for any interventional studies. Also, much of the clinical research in neonatology is focused on the highest risk, extremely preterm babies, and we have about 60 babies like this per year at UVA. So, in my research, we collaborate with at least 15 other large academic NICUs, and this will allow us to have enough babies with various conditions to get both statistically significant and clinically meaningful results.
Q: How do these collaborations improve patient care and accelerate research progress?
Fairchild: We couldn’t get outside funding or enough patients without professional collaborations. But even more important is our collaboration with parents in the NICU. We owe a debt of gratitude to the parents of our NICU babies. And, maybe the only reason their baby survived is because, 20 years ago, someone said yes to research.
At academic centers like UVA, babies can have access to groundbreaking new therapies. But, of course any research involving new interventions requires consent from parents. The reason preterm infants survive and do so well now is that over the past decades parents have allowed their babies to be part of research studies and beneficial therapies were discovered. Some parents choose not to have their babies participate in research—which is fine, it’s a very scary thing to have a sick baby in the NICU and there’s a lot of uncertainty. But some parents feel that being part of a research study might help their baby or others in the future.
Q: What’s one thing most people don’t know about you?
Fairchild: I play the cello and have since I was a kid. I currently play over the mountain in the Waynesboro Symphony. Family-wise, my husband and I just bought a house on the Rappahannock. Our son and daughter are students at UVA, and we’re looking forward to a lot of three-day weekends on the river!