The Power of Networks

Clinical research networks bring together scientists, clinicians, and community stakeholders to identify important clinical questions and design and conduct high-quality studies to answer them. Scientific evidence generated by such studies can impact clinical care, as several recent findings from NICHD’s networks demonstrate.

Last month, the Neonatal Research Network (NRN) reported that hydrocortisone is no more effective than placebo at preventing bronchopulmonary dysplasia (BPD), a chronic respiratory disease common in extremely preterm infants who require oxygen and ventilator therapy. While this may be considered a “negative” finding, in that the drug did not improve outcomes, it nonetheless provides us with critical information to guide clinical care: hydrocortisone is ineffective for BPD prevention, and we must pursue alternate strategies.

Children’s responses to medical therapies frequently differ from those of adults, yet pediatricians too often must make decisions according to best guesses based on adult studies. To help fill these knowledge gaps, NICHD’s Pediatric Trials Network (PTN) studies the formulation, dosing, efficacy, and safety of drugs in pediatric populations. For example, a PTN clinical trial showed that three broad-spectrum antibiotic combinations commonly used to treat complicated intra-abdominal infections in preterm infants are equally safe. These safety data will help guide recommended medication label changes for premature babies with such infections, as well as provide reassurance to those who make care decisions for these infants.

Our networks also strive to optimize the delivery of care. Traditional CPR training teaches healthcare providers to provide the same depth and rate of compression to every child, regardless of their age, size, or underlying illness. A clinical trial conducted within the Collaborative Pediatric Critical Care Research Network (CPCCRN) compared standard CPR with a more personalized approach in which providers were trained to adjust their CPR technique according to how the child’s blood pressure responded. Among patients in pediatric intensive care units who experienced cardiac arrest, there was no significant difference in survival between those receiving personalized CPR and those receiving standard CPR. However, both groups achieved higher-than-expected survival rates, nearing 60%, and the personalized training did improve blood pressures during CPR.

In some cases, study findings can be translated into tools to guide clinical decision-making. NICHD’s Maternal-Fetal Medicine Units (MFMU) Network recently updated its calculator to estimate the likelihood of having a successful vaginal birth after cesarean. Pregnant people and their healthcare providers can use these estimates to inform the decision about whether to attempt a vaginal delivery. The updated calculator excludes the variables of race and ethnicity, which are social rather than biological factors, in response to concerns that their inclusion could help perpetuate health disparities.

Notably, all of these advances were published during the COVID-19 pandemic, which has posed numerous obstacles for investigators, clinical site staff, and research participants. As they navigated these challenges, many of NICHD’s networks also leveraged their infrastructure and expertise to tackle emergent research questions raised by the pandemic. For example, the PTN is studying the dosing and safety of drugs being used to treat children with COVID-19, and work by the MFMU Network is providing critical information about the effects of COVID-19 during pregnancy and postpartum.

Beyond their scientific outputs, research networks foster team science and promote the development of junior investigators. Networking is essential to build relationships and help identify collaborative opportunities. For example, the independent investigators awarded supplemental funding to explore potential effects of COVID-19 vaccination on menstruation have come together at monthly meetings to discuss progress and exchange ideas. I encourage everyone—from trainees to senior scientists—to actively explore ways to network with your colleagues and potential collaborators.