Research Training

In the Division of Neonatal-Perinatal Medicine, we believe that effective training is supported in a milieu in which scientists with a broad variety of interests and backgrounds come together to share ideas and provide one-on-one mentoring of junior physician-scientists. Such a milieu exists in the neonatal training program at Duke and the Neonatal-Perinatal Research Institute (NPRI), a multidisciplinary group of basic and clinical researchers dedicated to the study of developmental biology and health care problems of the neonate. The training of physician-scientists to carry out outstanding research is an integral part of the mission of the Division, the NPRI, the Department of Pediatrics and the Duke School of Medicine.

Neonatology research opportunities at Duke encompass both the basic and clinical sciences. In addition, many fellows choose to engage in masters level training encompassing a myriad of clinically relevant fields. Examples include, but are not limited to Masters degrees in Clinical Research, Public Health, Genomics, Medical Informatics, and Health Care Policy.

Fellows may choose a scholarship pathway (Clinical Research, Basic/Translational Research, Quality Improvement, NICU Follow Up, or Palliative Care/Ethics) to guide their education and career development during their time at Duke.

• Basic/Translational Science Pathway
• Clinical Research Pathway
• Neurodevelopmental Follow-up and Outcomes Pathway
• Quality Improvement Sciences Pathway
• Palliative Care and Bioethics Pathway

The aim of mentored research is to provide fellows with the background and qualifications for successful independent research. During the first year, discussions with faculty and other advisors lead to an individualized research training plan, which depends upon the fellow’s academic and professional goals. The research mentorship within the Division follows the investigative interests of the faculty. Research is conducted within the aegis of the Neonatal Perinatal Research Institute (NPRI). The NPRI is comprised of investigators within the Divisions of Neonatal Medicine, Maternal Fetal Medicine, and Obstetric Anesthesiology, with affiliated faculty and advisors in Internal Medicine (Pulmonary Medicine, Neurology, Immunology), Neurobiology, Cell Biology, Genetics, and The Sanford Institute of Public Policy. At the start of the fellowship each fellow is aligned with a faculty member within the NPRI or its affiliates. Depending on the fellow’s interests and future plans, research mentors can be chosen from any of the faculty at the Duke Medical School.

Basic/Translational Science Pathway

The Basic or Translational Science Research Pathway is designed to give young investigators the knowledge and skills needed to perform cutting-edge scientific research and succeed in the highly competitive environment of academic pediatrics. Moreover, one of the most significant goals of the program is to ensure that young physicians will be able to translate, for the benefit of patients, research findings into clinical practice.

During the first year, fellows work with faculty members and other advisors to develop an individualized research training plan. This plan is custom tailored to meet the fellow’s academic and professional goals.

Research mentorship within the Division follows the investigative interests of the faculty:
1) Prenatal and postnatal mechanisms of central nervous system injury and repair,
2) Development and function of the neonatal immune system, and
3) Preterm infant microbiome and postnatal growth.

Research is conducted within the aegis of the Jean & George Brumley, Jr., Neonatal Perinatal Research Institute (NPRI). At the start of the fellowship each fellow is aligned with a faculty member within the NPRI or its affiliates. Depending on the fellow’s interests and future plans, research mentors can be chosen from any of the faculty at the Duke Medical School. A formal mentorship committee is established for each fellow.

The NPRI is comprised of investigators within the Divisions of Neonatology, Maternal Fetal Medicine, and with affiliated faculty and advisors in:

• Internal Medicine
• Neurobiology
• The Multidisciplinary Neuroprotection Laboratories
• Cell Biology
• Duke Institute for Genomic Sciences & Policy
• Center for Population Genomics & Pharmacogenetics
• Center for Human Genomics
• the Pratt School of Engineer
• The Stedman Center for Nutrition

Clinical Research Pathway

The Clinical Research pathway is designed to provide young clinical scientists with the tools and skills needed to perform innovative clinical research, translating and testing basic science discoveries in the clinical arena.

The program's clinical research training is based on a unique master's program, the Masters of Health Sciences in Clinical Research, that Duke has developed to train clinical researchers. Clinical research trainees are required to participate in core courses required for this degree.

The trainees, working with mentors experienced in clinical research and committed to this program, may select from a broad range of research initiatives based within:

• Neonatal-Perinatal Research Institute (NPRI)
• Duke Clinical Research Institute (DCRI)
• NICHD-sponsored Neonatal Network
• The Duke Center for Genomic and Computational Biology
• Duke Center for Human Genetics

The DCRI is the largest academic clinical research organization in the United States and home to the Pediatric Clinical Research Initiative. The goals of the DCRI are to advance medical care and improve patient survival and quality of life by developing and directing multi-centered clinical trials in pediatric therapeutics, train pediatricians in clinical research, and, through mentoring, help them develop successful research careers. Fellows can choose to apply for the DCRI Clinical Research Fellowship program which provides additional training and mentorship during the 2^nd and 3^rd years of clinical fellowship.

The NICHD Neonatal Research Network (NRN) was established in 1986 to improve the care and outcome of neonates, especially very-low-birth-weight infants. Operating under competitive cooperative agreements, the NRN includes investigators from 16 university-based clinical centers, a Network Data Coordinating Center, and NICHD staff. The Network was developed to address major problem areas in neonatology through multicenter randomized controlled trials.

Neurodevelopmental Follow-Up and Outcomes Pathway

This pathway is designed to provide excellent clinical training in the acute and convalescent care of premature and sick full term infants as well as the medical and neurodevelopmental follow-up care required for these infants post-discharge. Fellows who complete this training will be able to apply their specialized knowledge and expertise to careers in pediatric academic positions and outpatient pediatric clinical practices across the country. 

Fellows will be trained in best practices for providing convalescent care, discharge planning and comprehensive post-discharge care for premature and critically ill term or near-term infants.

They will gain experience in dealing with ongoing neonatal morbidities such as:

• chronic lung disease
• gastroesophageal reflux
• brain injury
• growth
• nutrition and feeding difficulties
• early motor
• other developmental problems and psychosocial problems common in high-risk infants

Fellows will also become familiar with expected outcomes of various neonatal conditions and the early precursors of cerebral palsy and other developmental disorders. They will learn to differentiate between the transient neurologic abnormalities commonly seen in premature and other sick newborn infants and the true warning signs that predict later neurologic and developmental problems. The fellow will also receive comprehensive training in the methods for conducting neurodevelopmental follow-up, and other outcome research.

In addition to the service time in the NICU (standard fellowship requirement), fellows will have the following opportunities:

• Clinical service time rounding with the complex care team
• Weekly participation in Developmental Rounds in the NICU
• Master's degree in Clinical Research from the Duke Center for Clinical Research (optional). This program includes training in epidemiology and biostatistics as well as design of clinical trials.
• Electives in the following areas:
  • Neuroimaging (indications and interpretation)
  • Pediatric Cardiac Neurodevelopmental clinic
  • Neonatal neurology
  • Rehabilitation/CP clinic
  • Physical/occupational therapy
  • Speech/feeding disorders

Quality Improvement Sciences Pathway

Palliative Care and Bioethics Pathway

We believe that effective training to accomplish these goals is supported in a milieu in which scientists with a broad variety of interests and backgrounds come together to share ideas and provide one-on-one mentoring of junior physician-scientists. Such a milieu exists in the neonatal training program at Duke and the Neonatal-Perinatal Research Institute (NPRI), a multidisciplinary group of basic, clinical and health care researchers dedicated to the study of developmental biology and health care problems in the neonate. The training of physician-scientists to carry out outstanding research is an integral part of the mission of the Medical Center, the Division of Neonatal-Perinatal Medicine, and the NPRI.

In 2000, Duke became an active member of the NICHD - Neonatal Research Network. The Network is a collaboration between NICUs from academic medical centers across the US and a coordinating center and is dedicated to improving the quality of care for sick infants through the multicenter collaborative research. Neonatology fellows are encouraged to take part in clinical research under the auspice of the Neonatal Research Network.