The unifying theme of this PPG renewal is understanding the pathophysiology, and establishing the optimal management, of two of the most serious and frequently encountered conditions among critically ill, premature infants: anemia and thrombocytopenia. Current treatment for these conditions relies largely on transfusion of red blood cells and platelets?therapies that remain controversial and incompletely investigated. Prior research by our PPG group and others has established that many aspects of the pathophysiology of the anemia and thrombocytopenia of prematurity are unique. However, our understanding is incomplete. Hence, the goals of our renewal are to further define the mechanisms that give rise to these pressing and related clinical conditions, to optimize their treatment per such mechanistic knowledge, and consequently, to reduce both short- and long-term disabilities associated with these conditions. Our 4 interrelated projects, whose objectives are directly relevant to our unifying theme, include: Project 1 """"""""Optimized erythropoietin treatment of neonatal anemia,"""""""" PL JA Widness (and P Veng-Pedersen);Project 2 """"""""Pathogenesis and treatment of neonatal thrombocytopenia,"""""""" PL M Sola-Visner;Project 3 """"""""Preterm transfusions: brain structure/function outcomes,"""""""" PL PC Nopoulos;and Project 4 """"""""The role of neonatal anemia In learning and memory,"""""""" PL MK Georgieff. Core A (""""""""Administrative, statistical, and research personnel"""""""") and Core B (""""""""Laboratory and database,"""""""" PL DM Mock) will provide support for all projects. To enhance effectiveness, our program has expanded to involve four (vs. two) performance sites, so that data can be shared among Projects 1, 2 and 3 (i.e. data from the same infants will be used In studies at multiple sites). Our history of success conducting multisite research will be invaluable in coordinating studies across the various performance sites. Because our Program rests on a highly-qualified, multidisciplinary group of new and experienced investigators, our renewal program consists of unique and collaborative research teams capable of accelerating the acquisition of knowledge vital to the fields of neonatal anemia and thrombocytopenia. Over the past 17 years, our productive PPG group (200 publications) has made a substantial impact on clinical practice and research in neonatal transfusion medicine and hematology. Our program embraces and exemplifies the synergistic P01 approach, which has and will enable us to make more rapid progress than any of us could individually. With this renewal, we are poised to continue to challenge paradigms and advance knowledge, as we build on prior results and maximize collaboration.

Public Health Relevance

The research proposed will enhance understanding of the pathophysiology of the 2 most important, common and costly hematological conditions encountered in the NICU: anemia and thrombocytopenia. It will do so by providing definitive answers to important, challenging, and timely clinical questions and by expanding potential treatment options to reduce costly short- and long-term consequences of these 2 challenging conditions. Results of our studies support the NIH's mission of reducing the burdens of illness and disability.

National Institute of Health (NIH)
National Heart, Lung, and Blood Institute (NHLBI)
Research Program Projects (P01)
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Heart, Lung, and Blood Program Project Review Committee (HLBP)
Program Officer
Mondoro, Traci
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University of Iowa
Schools of Medicine
Iowa City
United States
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Cakir, Bertan; Liegl, Raffael; Hellgren, Gunnel et al. (2018) Thrombocytopenia is associated with severe retinopathy of prematurity. JCI Insight 3:
Nalbant, Demet; Cancelas, José A; Mock, Donald M et al. (2018) In premature infants there is no decrease in 24-hour posttransfusion allogeneic red blood cell recovery after 42 days of storage. Transfusion 58:352-358
Benavides, Amanda; Metzger, Andrew; Tereshchenko, Alexander et al. (2018) Sex-specific alterations in preterm brain. Pediatr Res :
Mock, Donald M; Nalbant, Demet; Kyosseva, Svetlana V et al. (2018) Development, validation, and potential applications of biotinylated red blood cells for posttransfusion kinetics and other physiological studies: evidenced-based analysis and recommendations. Transfusion 58:2068-2081
Sparger, Katherine A; Ramsey, Haley; Lorenz, Viola et al. (2018) Developmental differences between newborn and adult mice in response to romiplostim. Platelets 29:365-372
Patel, Ravi M; Josephson, Cassandra D; Shenvi, Neeta et al. (2018) Platelet transfusions and mortality in necrotizing enterocolitis. Transfusion :
Teramo, Kari A; Klemetti, Miira M; Widness, John A (2018) Robust increases in erythropoietin production by the hypoxic fetus is a response to protect the brain and other vital organs. Pediatr Res :
MacQueen, B C; Christensen, R D; Henry, E et al. (2017) The immature platelet fraction: creating neonatal reference intervals and using these to categorize neonatal thrombocytopenias. J Perinatol 37:834-838
Schmidt, Robert L; Mock, Donald M; Franco, Robert S et al. (2017) Antibodies to biotinylated red blood cells in adults and infants: improved detection, partial characterization, and dependence on red blood cell-biotin dose. Transfusion 57:1488-1496
Wallin, Diana J; Zamora, Tara G; Alexander, Michelle et al. (2017) Neonatal mouse hippocampus: phlebotomy-induced anemia diminishes and treatment with erythropoietin partially rescues mammalian target of rapamycin signaling. Pediatr Res 82:501-508

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