New neonatal 3-Tesla MRI transporter promotes innovative pediatric research

Medical School researchers are using a neonatal transporter that can go directly into a magnetic resonance imaging (MRI) scanner as part of a novel study to identify acute brain injury in extremely premature infants.

“One of the many challenges in comprehensively evaluating acute brain injury in these infants is the risk of removing them from the neonatal intensive care unit (NICU) for even a standard MRI. It could compromise their health. These babies are very susceptible to temperature change and a host of other difficulties,” said Dr. Nehal Parikh, principal investigator of the study and assistant professor of pediatrics. “This pilot study will help us establish the safety of this MRI transporter and explore new measures of detecting brain injury by using blood work, or proteomics, and multichannel electroencephalography (EEG).”

Extremely premature babies are susceptible to damage of the communication channels in their brain called white matter. In most cases, the injury is not detected within days, making it difficult, if not impossible to treat, said Parikh, a neonatologist at Children's Memorial Hermann Hospital. “This type of injury cannot be diagnosed without using a MRI,” he added.

According to Parikh, survival rates for preterm infants have improved dramatically while the incidence of neurological impairment remains unchanged. Therefore, the overall number of children with disabilities is increasing; half of all neurologic disabilities in children are related to preterm births, according to a 2005 March of Dimes report.

One of only two in the country, the transporter provides everything the infant can receive while being cared for in an NICU incubator. The transporter keeps the baby warm, provides humidity needed for the first 10 days of life, contains an intravenous (IV) pole with pumps that are shielded from the MRI magnet, and includes an MRI-compatible ventilator.

“Without that, you couldn't scan a baby who was on a ventilator. The transporter also has a built-in MRI head coil, a heart rate monitor, and pulse oximeter that detects the level of oxygen in the blood,” Parikh said.

The transporter is housed at the Medical School. When needed, it can be taken to the Children's Memorial Hermann Hospital's NICU where an infant will be removed from the incubator and placed inside the transporter's incubator. The transporter and the infant, while remaining in the controlled environment of the MRI transporter, can then be scanned in a high-powered 3-Tesla MRI at Memorial Hermann-Texas Medical Center or the Medical School. A 3-Tesla scanner has a strong magnet and produces high quality images.

UT researchers will recruit 15 hospitalized mothers at Children's Memorial Hermann who deliver between 23 and 29 weeks gestation and 10 healthy full-term newborns to help evaluate how best to protect infant brains. Researchers will examine the infants’ blood, urine, placenta, and cord blood, looking for a correlation among those test results, EEG, and MRI.

“If a connection is made and validated in a larger study, it should allow us to select high-risk infants for randomized trials on how to protect the brain,” Parikh said. “This has been one of the big hurdles contributing to the lack of effective therapies for extremely preterm infants.”

“Dr. Parikh is among the few investigators in the world capable of doing very sophisticated brain imaging in small infants. This work complements our National Institutes of Health Neonatal Network by performing innovative imaging and builds upon the Medical School's continuum of brain research,” said Dean Giuseppe Colasurdo.

The study was funded by a UT Pilot Grant and Dean's Research Award through the Medical School and a K23 Career Development grant from the National Institute of Neurological Disorders and Strokes.

Co-investigators include Dr. Sean Blackwell, associate professor of obstetrics, gynecology and reproductive sciences; Dr. William Dubinsky, Jr., professor of diagnostic and interventional imaging; Dr. Nina Tatevian, associate professor of pathology and laboratory medicine; Katrina Burson, research coordinator; Dr. Robert Lasky, professor of pediatrics; and Dr. Ponnada Narayana, professor of diagnostic and interventional imaging.

— Melissa McDonald, Office of Institutional Advancement, Media Relations

Patel appointed to new MH-TMC position to focus on quality

In line with the national effort to improve quality outcomes in health care institutions across the United States, Memorial Hermann-Texas Medical Center recently created the position of assistant chief medical officer and executive director of critical care, and Dr. Bela Patel has been appointed to the new role.

As assistant chief medical officer, Patel, associate professor of internal medicine, is focusing on the hospital’s quality improvement program, with a special emphasis on reducing mortality, hospital-acquired infections, and complications. She also is working to enhance the educational opportunities of medical students and house staff members and is providing leadership support for clinical research.

In her role as executive director of critical care, Patel is concentrating her efforts on standardizing the clinical approach to critical care and elevating the standard of critical care medicine throughout the hospital.

“It is with a special sense of pride that we welcome Dr. Patel to this position,” said Dr. Jeffrey Katz, chief medical officer of Memorial Hermann-TMC. “She is a graduate of The University of Texas Medical School at Houston and has spent much of her career taking care of patients at Memorial Hermann.”

After earning her degree from the UT Medical School in 1993, she completed an internal medicine residency and a fellowship in pulmonary, critical care, and sleep medicine at the university, where she has served as a faculty member since 1999.

“Many of you know Dr. Patel as the medical director of the MICU/MIMU, but her influence on us has been much broader, and many patients have left this hospital in better health because of her care,” Katz said. “She is well trained in our practices and has built firm and lasting relationships with our medical staff and hospital employees. She is perfectly positioned to have a positive and lasting impact on our organization.”

Patel is continuing to serve as the division director for critical care medicine and vice chair of medicine at the Medical School. In addition to these leadership roles, she has also served as the chief of pulmonology/critical care medicine at Lyndon B. Johnson General Hospital.

“Her training and experiences have resulted in a career built on excellence in clinical critical care, a genuine dedication to discovery, and an ongoing commitment to the educational process,” Katz said.

Patel has a broad range of knowledge both clinically and in quality improvement, and is a graduate of the UT Clinical Safety and Effectiveness Course as well as the Physician Quality and Safety Leadership Academy. She also serves as the co-chair of the Memorial Hermann System Critical Care Subcommittee.

— Memorial Hermann-TMC Campus

McCarthy appointed to AHA’s Mission: Lifeline national task force

Dr. James McCarthy, assistant professor of emergency medicine, has been appointed to the prestigious National American Heart Association’s Mission: Lifeline Emergency Cardiac Care Task Force. He will work side by side with colleagues from around the country to decrease death and disability from heart attacks. The task force, comprised of about 20 members, leads the EMS System Assessment and Improvement portion of the initiative, ensuring its successful progress.

In addition, McCarthy is co-leading the AHA Mission: Lifeline Initiative in the Houston area. The goal of the SETTRAC Mission: Lifeline Cardiac Care committee is to improve outcomes for patients experiencing an emergent cardiac event in the nine county SETTRAC region, which includes Houston.

McCarthy also is the medical director of the Emergency Center at Memorial Hermann-Texas Medical Center.

“He is a true patient advocate and has played a key role in the success of the Mission: Lifeline initiative in the Houston region,” said Loni Denne, senior director of Mission: Lifeline for the AHA South Central Affiliate. “We are grateful to have physicians like Dr. McCarthy who are willing to support the organization at both the local and national level, working with us in every aspect of the American Heart Association.”

— Tiffany Travis, American Heart Association

New clinical reference tool available

Access to DynaMed, a clinical reference tool created by physicians for physicians and other health care professionals for use primarily at the point-of-care, is now available for all faculty, residents, students, and staff at The University of Texas Health Science Center at Houston. The HAM-TMC Library will hold DynaMed instruction classes beginning in January 2010. Registration for all HAM-TMC Library classes is available online.

DynaMed and other electronic resources are available through remote access through the HAM-TMC Library's Web site. Registration for remote access is easy, but you must register by using your UTHSC-H e-mail address. You will be issued a generic password delivered to your institutional e-mail account immediately, but you will be able to change the password upon receipt of the confirmation e-mail.

If you have any questions, please contact the Library at 713.799.7147.

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