Research training is a major focus of the fellowship training program and fellows are provided substantial protected time throughout their fellowship to engage in rich research experiences. The research program is designed to provide comprehensive scholarly training that prepares all trainees with the background and skills to successfully compete for academic faculty positions and extramural funding at the completion of their fellowship. Historically, the training program has produced an unusual number of leaders in academic Neonatology, including several Deans, Department Chairs, and Division Heads. Each trainee is matched with one or more faculty mentors who are actively involved in an area of research that is of mutual interest. Although many neonatal fellows are mentored by a faculty member within the Division of Neonatology, the program encourages fellows to consider a broad range of potential mentors. The program will assist in identifying potential mentors, both within the Department of Pediatrics and, when appropriate, from across the School of Medicine campus.
One of the most active areas of research within the Division of Neonatology is fetal and neonatal growth and metabolism. Past and ongoing studies address glucose and protein metabolism in the normal fetus and newborn, and more recent studies have focused more on the growth-restricted fetus. These studies attempt to define perturbations that cause growth restriction and identify potential therapies that might reverse these perturbations. These studies generally take a layered approach, with whole animal physiologic studies supported by investigation at the cellular and biochemical level. In addition to basic science studies in this area, several faculty members are involved in clinical research in nutrition.
Another highly productive area of research involving Neonatology faculty and fellows has been in the area of lung growth and development, particularly pulmonary vascular growth and function. Much of this work is done in collaboration with the Pediatric Heart Lung Center, a multidisciplinary group of pulmonologists, neonatologists, cardiologists, and intensivists interested in understanding how the lung normally develops and functions and on the mechanisms that underlie disorders such as bronchopulmonary dysplasia and persistent pulmonary hypertension of the newborn. These physiologic and molecular studies have led to several ongoing clinical trials, including a number of important studies on the applications of inhaled nitric oxide in newborn medicine.
A number of other areas of scholarly activity are available to Neonatology fellows, depending on their interests and career aspirations. Areas of active research include neonatal seizures and stroke, mechanisms and consequences of normal and abnormal placentation, the effects of maternal nutrition and weight gain on neonatal outcome, and genetic control of organogenesis. Among the many campus resources are the University of Colorado Cancer Center, the Barbara Davis Center for Childhood Diabetes, the Cardiovascular Pulmonary Research Laboratory, the Program in Molecular Biology, and the Program in Developmental Biology. For those interested in clinical studies, several faculty members in the division collaborate with the division of Maternal-Fetal Medicine in a number of areas, including active studies of maternal diabetes and obesity and their consequences on fetal and neonatal health. For those interested in epidemiological research, the division participates in the Vermont Oxford Network and in the newly formed Children’s Hospital National Consortium (CHNC). In addition, the Department of Obstetrics maintains a comprehensive database for mothers and babies delivered at University of Colorado Hospital. More recently, several members of the Division and Department have developed an interest in educational research, and state-of-the-art simulation facilities are available for studies at the University of Colorado Center for Professional Excellence.
Each fellow in the program is expected to undertake a substantive scholarly project during their training. As outlined in the following section, opportunities are available in a broad range of areas and with multiple different mentors. Many fellows choose to pursue research programs in large laboratories with several faculty members and trainees at various levels, with each trainee focusing on individual project. In general, research projects are designed to provide the trainee with broad, state-of-the-art training involving both in vivo and in vitro techniques. Fellows are expected to participate in all aspects of their individual research projects, including the development of hypotheses and study design, whole animal surgeries and in-vivo studies (when appropriate), cell and molecular biology techniques, data collection and analysis, and abstract/manuscript presentation. The division employs a number of professional research assistants who are available to help both faculty and fellows with studies and to ensure uninterrupted progress during periods of clinical commitment.
Research opportunities available to neonatology trainees are broad and varied. A significant strength of the division is its affiliation with and leadership of the Perinatal Research Facility. This state of the art laboratory allows interested neonatology faculty and fellows to engage in a broad spectrum of basic science research, including physiologic studies in chronically prepared fetal lambs and their mothers. In addition to in-vivo, whole animal studies, a large wet lab adjoins the large animal facility and allows researchers to conduct supporting molecular and cell biology studies. The division employs a number of professional research assistants who assist the faculty and trainees in conducting research and ensure that individual studies continue to progress during times when investigators have heavy clinical commitments.
For trainees interested in clinical studies, Children’s Colorado and the University of Colorado Hospital are both active sites of several clinical neonatal research studies. Five full-time research nurses who are dedicated to projects on maternal and neonatal health assist in coordinating patient recruitment and data collection at the two sites.
During the first 1-2 months of assigned research time, a trainee will typically meet with a number of potential mentors to discuss possible research projects and become familiar with different research programs. In the case of a basic science program, the fellow may “shadow” in individual labs in which they are interested. With the help of the Program Director, the goal is for the fellow to choose a mentor and research project in the fall of the first year. Once a research program is chosen, a timeline for research activity is developed by the mentor and the trainee. Broadly, the goal for basic science projects is for the fellow to have made sufficient progress that they are able to consider submission of an abstract to the Pediatric Academic Society Meetings by December of their second year. For fellows pursuing prospective clinical research programs, they should be recruiting patients by the second year of fellowship. In general, research time during the third year of fellowship should be spent analyzing data, undertaking additional experimentation as necessary based in initial data analysis and feedback, preparing presentations and manuscripts, and planning follow-up projects.
The Colorado Clinical and Translational Sciences Institute is a collaborative enterprise between University of Colorado Denver, University of Colorado at Boulder, six affiliated Hospitals and health care organizations, and multiple community organizations with resources to promote research and training that will advance health care and improve the public health. The CCTSI was established in 2008 with funding from the Clinical and Translational Science Award (CTSA) initiative of the National Institutes of Health (NIH). Through the CCTSI, Clinical Translational Research Centers (CTRCs) have been established at several affiliated hospitals, including The Children’s Hospital, University of Colorado Hospital, and Denver Health Medical Center. The CTRCs support research with clinical inpatient and outpatient space, inpatient research beds, nursing and research staff support, and core laboratory and nutrition services. To access CTRC resources, investigators submit a clinical protocol for review by the Scientific Advisory and Review Committee (SARC). The SARC review process gives investigators experience that may improve future COMIRB (Colorado Multiple Institutional Review Board) and grant applications. The CTRC also offers biostatistical collaboration/consultation for study design, including sample size and power calculations, data analysis, and manuscript preparation. To fulfill its mission to train future researchers, the CCTSI offers ongoing comprehensive educational programs in several areas, including Informatics, Biomedical Ethics, Biostatistics, and Study Design.
Towards the end of the first year of training, each fellow is assigned a Scholarly Oversight Committee (SOC), composed of at least 3 faculty members. The SOC meets every six months, at a minimum, to evaluate the fellow’s scholarly progress and to help provide support and direction. At the end of training, the SOC is responsible for determining whether the fellow’s work has met the American Board of Pediatric’s requirement for sub-board eligibility.