Neonatal medicine is the component of pediatrics which is responsible for the care of critically ill newborns, whether they are born prematurely or after a full nine months, and whether or not they have conditions which require the input and collaboration of other pediatric sub-specialists. Sick newborns are cared for in a Neonatal Intensive Care Unit (NICU) which is a highly technical environment in which new methods to treat sick newborns often occur before rigorously controlled studies of their safety and efficacy can be conducted. In November 1982, the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD) reviewed the need for better studies of the management of infants in NICUs. The NICHD recommended that cooperative, multi‐institutional studies be conducted by the medical community with the assistance of NICHD.
In response to this recommendation, the NICHD Neonatal Research Network (NRN) was established in 1986 to undertake multicenter clinical studies to investigate the safety and efficacy of treatment and management strategies to improve the outcome of sick newborns. By providing large populations through a network of centers using common protocols, questions could be answered more rapidly than by individual centers acting alone. The NRN structure promotes randomized controlled trials with short (during the hospitalization) and/or long term (neurodevelopmental) outcome. A well-planned and performed randomized trial provides the highest level of evidence in clinical medicine. The structure of the NRN also facilitates observational, longitudinal studies in the NICU.
Since 1986, the NRN has grown from seven to 18 academic centers across the United States. Every five years, a very competitive process takes place to determine participation in the NRN based on characteristics of the NICU, willingness to participate in multi-center trials, compliance with follow-up assessments in early childhood, and a track record of high performance on clinical trials.
Women & Infants Hospital, the major teaching affiliate of The Warren Alpert Medical School at Brown University for obstetrics and newborn medicine, has been selected to participate in the NRN for each five-year cycle since 1991. For the upcoming 2016 to 2021 cycle, Women & Infants has been successfully awarded another five year grant to participate in the NRN.
Abbot Laptook, MD
Neonatal Intensive Care Unit
101 Dudley Street, Providence, RI
(401) 274-1122, ext. 47421
The NRN has conducted multiple important clinical trials which have improved the outcomes of sick newborns and changed how neonatologists care for their patients. Not all trials performed by the NRN have changed clinical practice; even when this occurs, the results are important to guide neonatologists as to what treatments are not helpful and should not be used.