Spectral data shine light on placenta

preemie baby

A research project led by Subechhya Pradhan, Ph.D., aims to shed light on metabolism of the placenta, a poorly understood organ, and characterize early biomarkers of fetal congenital heart disease.

The placenta serves as an essential intermediary between a pregnant mother and her developing fetus, transporting in life-sustaining oxygen and nutrients, ferrying out waste and serving as interim lungs, kidneys and liver as those vital organs develop in utero.

While the placenta plays a vital role in supporting normal pregnancies, it remains largely a black box to science. A research project led by Subechhya Pradhan, Ph.D., and partially funded by a Clinical and Translational Science Institute Research Award aims to shed light on placenta metabolism and characterize possible early biomarkers of impaired placental function in fetal congenital heart disease (CHD), the most common type of birth defect.

“There is a huge information void,” says Pradhan, a research faculty member of the Developing Brain Research Laboratory at Children’s National Health System. “Right now, we do not have very much information about placenta metabolism in vivo. This would be one of the first steps to understand what is actually going on in the placenta at a biochemical level as pregnancies progress.”

The project Pradhan leads will look at the placentas of 30 women in the second and third trimesters of healthy, uncomplicated pregnancies and will compare them with placentas of 30 pregnant women whose fetuses have been diagnosed with CHD. As volunteers for a different study, the women are already undergoing magnetic resonance imaging, which takes detailed images of the placenta’s structure and architecture. The magnetic resonance spectroscopy scans that Pradhan will review show the unique chemical fingerprints of key metabolites: Choline, lipids and lactate.

Choline, a nutrient the body needs to preserve cellular structural integrity, is a marker of cell membrane turnover. Fetuses with CHD have higher concentrations of lactate in the brain, a telltale sign of a shortage of oxygen. Pradhan’s working hypothesis is that there may be differing lipid profiles and lactate levels in the placenta in pregnancies complicated by CHD.  The research team will extract those metabolite concentrations from the spectral scans to describe how they evolve in both groups of pregnant women.

“While babies born with CHD can undergo surgery as early as the first few days (or sometimes hours) of life to correct their hearts, unfortunately, we still see a high prevalence of neurodevelopmental impairments in infants with CHD. This suggests that neurological dysfunctional may have its origin in fetal life,” Pradhan says.

Having an earlier idea of which fetuses with CHD are most vulnerable has the potential to pinpoint which pregnancies need more oversight and earlier intervention.

Placenta spectral data traditionally have been difficult to acquire because the pregnant mother moves as does the fetus, she adds. During the three-minute scans, the research team will try to limit excess movement using a technique called respiratory gating, which tells the machine to synchronize image acquisition so it occurs in rhythm with the women’s breathing.

Sarah Mulkey receives NIH career development grant

Sarah Mulkey

Sarah B. Mulkey, M.D., Ph.D., a fetal-neonatal neurologist in the Division of Fetal and Translational Medicine at Children’s National Health System, has received a KL2 award from the Clinical and Translational Science Institute at Children’s National, which is funded through the National Institutes of Health. This grant, totaling $135,000 over two years, will allow Dr. Mulkey to reserve dedicated research time — apart from her clinical duties — to pursue a research project studying the autonomic nervous system in newborns.

Dr. Mulkey’s project will focus on developing a better understanding of this part of the nervous system — responsible for unconscious control of basic bodily functions, such as heart rate and breathing — in healthy, full-term babies, and how this system integrates with other brain regions responsible for mood and stress responses. Dr. Mulkey and colleagues then will compare these findings to those from babies whose autonomic nervous systems might have abnormal development, such as infants born pre-term or those with congenital heart defects or intrauterine growth restriction. The findings could help researchers develop new interventions to optimize autonomic nervous system development in vulnerable patients and improve long-term neurologic and psychological health in children.

“This award is an incredible opportunity for a young investigator since it provides protected time both for research and career development,” Dr. Mulkey says. “We need more clinicians in pediatric research to improve medical care and outcomes for children. This award makes it possible for me to devote significant time to research in order to contribute to new knowledge about babies throughout my career.”

To that end, NIH’s National Center for Advancing Translational Sciences has created a new LinkedIn page to highlight the innovative work of KL2 scholars.

Children’s sponsors medical and health app development workshop

Hackathon Winners

Team 10, also known as “The BabyDaddies,” won the hackathon for their presentation on BabyData: A medical app for neonatal care providers. Team members, from left to right, are Jessica Castillo, Mohammed Abu-Rub, Saud Aljuhani and Jessica Herstek.

The Clinical and Translational Science Institute at Children’s National (CTSI-CN) recently sponsored a Medical and Health App Development Workshop in collaboration with The George Washington University (GW). Kevin Cleary, Ph.D., technical director of the Bioengineering Initiative at Children’s National Health System, and Sean Cleary, Ph.D., M.P.H., associate professor in epidemiology and biostatistics at GW, created this event to provide an interactive learning experience for those interested in developing medical and health software applications.

Not your average workshop, attendees had the opportunity to network, gain expert knowledge and participate in a group contest for a chance to win up to $10,000 in funding toward prototype development. To kick off events, attendees heard from presenters on the following topics:

  • Human factors: Shelly Heller, Ph.D., professor of the computer science department at GW
  • User interface prototyping: Tim Wood, Ph.D., assistant professor of the computer science department at GW
  • Regulatory environment: Linda Ricci, associate director for digital health within the Office of Device Evaluation, The Food and Drug Administration

Ahead of the workshop, the Children’s National and GW communities submitted ideas for consideration. Judges selected ten ideas for development at the workshop and organized teams of participants around each idea. Teams were judged on their overall presentation, durability of the application, and potential impact in the medical and health world. After careful deliberation, Team 10, also known as “The BabyDaddies,” won for their presentation on BabyData: A medical app for neonatal care providers. The newborn care mobile application aims to calculate the most commonly used values to promote efficient and evidence-based care for newborns in their first hours, days and weeks of life.

“Although some calculations are simple, a lot of time could be saved when you multiply those calculations by seeing 20 to 40 newborns a day,” says Jessica Herstek, M.D., Children’s National project lead and idea originator. “I wanted to create something easy that could help care providers on a day-to-day basis.”

Dr. Herstek is now working with CTSI-CN to bring the application to life. BabyData will feature calculators for measurements, weight assessments, risk evaluations, gestational and chronological age, nutrition, hydration, Group B Streptococcal prophylaxis and glucose infusion rate, all things currently being assessed manually. Medical providers who care for newborns in inpatient, emergency and outpatient settings will have all the resources they need consolidated into one field-specific calculator application.