Human Milk Nutrition
Our Division is focused on optimizing the delivery of human milk to the premature infant. Recognizing the numerous benefits of human milk to the vulnerable premature infant, we developed a premature infant nutrition program called SPIN (Supporting Premature Infant Nutrition) to establish a Center of Excellence in human milk nutrition. This is the first combined nutrition/lactation multidisciplinary team approach we know of in the country. As part of this initiative, we recruited a highly trained promising nutritional scientist, Dr. Lars Bode, who has been leading the way in the country on demonstrating multiple ways that abundant sugars found in human milk called oligosaccharides can improve health and disease both in adults and in newborns. Our Division research was one of the first to introduce a rapid point-of-care method of measuring the nutritional content of human milk so that we may be able to study more customized ways to help premature babies grow during the nutritional emergency state they are in for the first few months of life. Our SPIN program has been sought out now by numerous other institutions across the country as a best practice model and is openly available through our SPIN website (www.spinprogram.ucsd.edu).
Point-of Care Ultrasound
Dr. Jae Kim is one of the leaders in the use of real-time bedside ultrasound in the sick newborn. We have used it to evaluate intra-abdominal disorders and characterize bowel motility and function. We have high resolution ultrasound probes to allow such examinations and our results to date have demonstrated that we are able to diagnose bowel obstruction that was not discovered using all other current modalities. Dr Kim has also demonstrated that real-time ultrasound can detect air leaks within the chest and the position of endotracheal tubes while avoiding exposure of the infant to ionizing radiation. These exams can be performed in seconds and thus precious time is not wasted while waiting for an X-ray. Dr Kim has worked with GE Healthcare to develop new ultrasound devices to facilitate the positioning of central catheters during placement. Using real-time ultrasound he has already demonstrated that such techniques result in reduced delays in the discovery of misplaced catheters, and facilitates proper initial placement. Our Division will continue its leading edge research in this area in collaboration with industry, but will also develop unique new tools to further facilitate bedside diagnosis while avoiding the need for radiation exposure and transport of infants for other studies – such as CT scan and fluoroscopy.
The Prince laboratory studies the basic mechanisms regulating structural lung morphogenesis. Because many neonatal lung diseases involve defects in lung formation, the Prince lab investigates the genetic components and signaling pathways required for normal airway formation and cell differentiation. By using novel transgenic mouse models and state of the art imaging techniques, researchers in the Prince lab have been studying the molecular mechanisms regulating cell migration and movement, interactions between cells and the extracellular matrix, and how gradients of growth factor expression control 3-dimensional formation of intricate lung structures. More recent studies have also investigated the factors regulating the formation of stem cell populations during lung development and what role these cells might play in both normal development and in disease pathogenesis.
Development of the Innate Immune System
The preterm neonate is susceptible to infections. Not only can microbial pathogens cause life-threatening diseases such as sepsis and necrotizing enterocolitis, but the normal immune response to these pathogens can also disrupt normal development. Unfortunately, much remains unknown about how the immune system matures during normal development and following preterm delivery. The Prince laboratory is investigating maturation and function of fetal lung macrophages. Present from the earliest stages of development, macrophages are the primary sites of lung inflammatory signaling. However, there are dramatic changes in macrophage phenotype that occur during normal development. How these changes affect the ability to respond to infection and injury remain unknown. Collaborations involving the Prince lab are also studying how early exposure to pathogenic bacteria or microbial products can affect the numerous immune cells in the developing gastrointestinal tract.