Annemarie Stroustrup

Chronic lung disease of prematurity (CLD) is a common complication of preterm birth with a complex pathology. Recent epidemiologic studies have identified a link between neonatal exposure to di(2-ethylhexyl) phthalate (DEHP), frequently used in medical equipment, and the development of CLD. We hypothesize that DEHP exposure in the early neonatal period contributes to lung injury in newborn rats. Newborn rat pups were raised in one of the following environments: room air (RA), RA + DEHP, hyperoxia (60% oxygen), and hyperoxia + DEHP. Ambient DEHP was inhaled at a dose of 25 mg/m³ for 6 h daily for 14 days. Lung tissue and blood samples were collected on the 14th day of life. Independent exposure to DEHP and hyperoxia resulted in thicker pulmonary septal walls, fewer alveoli, increased pulmonary polymorphonuclear leukocytes and myeloperoxidase (MPO) activity and decreased expression of CD31 on endothelial cells in lung tissue. Additionally, DEHP-exposed rats showed higher serum malondialdehyde (MDA) levels and reduced vascular endothelial growth factor (VEGF) mRNA and protein levels compared to controls. Our experiments demonstrate that inhaled DEHP, with or without hyperoxia, resulted in a similar pattern of morphological lung injury and inflammation characteristic of CLD, suggesting an association with CLD of prematurity.

The American Board of Pediatrics (ABP) has proposed a competency-based fellowship model offering a 2-year clinical pathway with 18 training blocks and no scholarly requirement. This position statement, representing neonatal-perinatal medicine (NPM) training program directors, division leaders, and key stakeholders, contends that the model is not viable for NPM training. Compressing 18 clinical blocks into 24 months would require approximately 3500 annual training hours, nearly double a sustainable NICU workload, approaching Accreditation Council for Graduate Medical Education duty-hour limits, while reducing didactic education by one-third. Survey data from 110 of 111 NPM programs show 76% opposition. Concerns include trainee wellness, reduction in program complement, workforce and funding implications, and the erosion of scholarly training essential to advancing neonatal care. We propose alternatives, including a 2-year residency + 3-year fellowship (2 + 3) pathway and restructured residency tracks, addressing competency gaps while preserving training quality, duration, and collaborative governance.

Chronic lung disease of prematurity (CLD) is a common complication of preterm birth with a com-plex pathology. Recent epidemiologic studies have identified a link between neonatal exposure to di(2-ethylhexyl) phthalate (DEHP), frequently used in medical equipment, and the development of CLD. We hypothesize that DEHP exposure in the early neonatal period contributes to lung injury in newborn rats. Newborn rat pups were raised in one of the following environments: room air (RA), RA + DEHP, hyperoxia (60% oxygen), and hyperoxia + DEHP. Ambient DEHP was inhaled in a dose of 25mg/m3 for 6 hours daily for 14 days. Lung tissue and blood samples were collected on day 14 of life. Independent exposure to DEHP and hyperoxia resulted in thicker pulmonary septal walls, fewer alveoli, increased pulmonary polymorphonuclear leukocytes and myeloperoxidase (MPO) activity and decreased expression of CD31 on endothelial cells in lung tissue. Additionally, DEHP-exposed rats showed higher serum malondialdehyde (MDA) levels and reduced vascular endothelial growth factor (VEGF) mRNA and protein levels compared to controls. Our experiments demonstrate that inhaled DEHP, with or without hyperoxia, resulted in a similar pattern of morphological lung injury and inflammation characteristic of CLD, and a causative link to CLD of prematurity.

No standard work assignment exists for practicing neonatologists in the United States. Unlike other types of care providers in the neonatal intensive care unit who work under standard shift or work hour expectations, attending neonatologist staffing models vary significantly by job task, shift length, in-person or remote coverage responsibility, ambulatory or inpatient practice, and total clinical versus non-clinical commitments among other variables. Due to the diversity of clinical and non-clinical responsibilities of practicing neonatologists, transparent and equitable staffing models can be challenging to design and execute. We present a flexible approach to neonatologist scheduling that has been implemented effectively at two academic medical centers with multiple sites and types of neonatology clinical practice. This model allows for clear delineation of time dedicated to a variety of clinical and non-clinical activities to allow both clinical and administrative leadership clarity on the full range of professional responsibilities of a practicing neonatologist.

The purpose of this report is to introduce the research community to the Pediatric Development Research Domain of the NIH–supported PhenX Toolkit. See more.