Selected Podcast
Neonatal Research Network, the Maternal Fetal Medicine Unit Network, and the Global Network
Dr. Wally Carlo has agreed to be interviewed in an upcoming PedsCast podcast. He is the Division Director of Pediatric Neonatology at Children’s/UAB, holds the Edwin M. Dixon Professor of Pediatrics endowed chair and is a world-renowned neonatologist. He would like to highlight clinical trials that we are currently participating in, as well as the Maternal Fetal Network, one of three perinatal networks on the NIH that we belong to. UAB/COA is the only institution that belongs to all three – the MFM, NRN and the Global Network.
Featured Speaker:
Education
Undergraduate - Bachelor of Science
University of Puerto Rico, Mayaguez, Puerto Rico
Medical School - University of Puerto Rico Medical Sciences Campus, San Juan, Puerto Rico
Pediatric Internship and Residency - University Children's Hospital, Puerto Rico Medical Center, Puerto Rico Chief Resident in Pediatrics
Neonatology Fellowship - Rainbow Babies and Children's Hospital, OH
My main research interest is in clinical research including the design, implementation, data analysis, and reporting of neonatal and childhood research performed in developing countries and in the US, including single center trials and multicenter trials such as the First Breath Trial, the BRAIN-HIT Trial, and the SUPPORT Trial. I lead the UAB sites of the NIH-funded networks including the Global Network for Women’s and Children’s Health Research and the Neonatal Research Network. I have successfully implemented two large scale multicenter studies in 6 developing countries that enrolled over 190,000 babies and resulted in large and significant reduction in neonatal and perinatal mortality. I developed innovative devices including a high frequency ventilator, a flow interrupter to perform pulmonary function testing, and a low-cost oxygen air blender. I am focused on reducing mortality and major morbidities during early childhood in the US and developing countries funded by the NIH.
Waldemar Carlo, MD
Waldemar Carlo, MD is the Director, Chronic Lung Disease Prevention Program, Home Readiness Program, Early Developmental Intervention ProgramEducation
Undergraduate - Bachelor of Science
University of Puerto Rico, Mayaguez, Puerto Rico
Medical School - University of Puerto Rico Medical Sciences Campus, San Juan, Puerto Rico
Pediatric Internship and Residency - University Children's Hospital, Puerto Rico Medical Center, Puerto Rico Chief Resident in Pediatrics
Neonatology Fellowship - Rainbow Babies and Children's Hospital, OH
My main research interest is in clinical research including the design, implementation, data analysis, and reporting of neonatal and childhood research performed in developing countries and in the US, including single center trials and multicenter trials such as the First Breath Trial, the BRAIN-HIT Trial, and the SUPPORT Trial. I lead the UAB sites of the NIH-funded networks including the Global Network for Women’s and Children’s Health Research and the Neonatal Research Network. I have successfully implemented two large scale multicenter studies in 6 developing countries that enrolled over 190,000 babies and resulted in large and significant reduction in neonatal and perinatal mortality. I developed innovative devices including a high frequency ventilator, a flow interrupter to perform pulmonary function testing, and a low-cost oxygen air blender. I am focused on reducing mortality and major morbidities during early childhood in the US and developing countries funded by the NIH.
Transcription:
Neonatal Research Network, the Maternal Fetal Medicine Unit Network, and the Global Network
Dr Cori Cross (Host): Welcome to Peds Cast, a podcast brought to you by Children's of Alabama. I'm pediatrician, Dr. Cori Cross. Today, we'll be speaking with Dr. Wally Carlo. He is the Division Director of Neonatology at Children's Hospital of Alabama and at University of Alabama at Birmingham. He holds the Edwin M. Dixon Professor of Pediatrics Endowed Chair and is a world-renowned neonatologist. Thank you, Dr. Carlo, for joining us today.
Dr Waldemar Carlo: Thank you very much for having me here.
Host: So, tell us about the Neonatal Research Network. It's part of the NIH's Perinatal Network. Correct?
Dr Waldemar Carlo: It is correct. The Neonatal Research Network is one of the three NICHD Perinatal Networks. These are clinical networks to make major advances in perinatal care.
Host: And it's my understanding that Children's Hospital of Alabama is a member of all three of the NIH's perinatal networks, and that's a huge accomplishment. Isn't that correct?
Dr Waldemar Carlo: That's correct. We have now had for over 20 years the three networks. These are three major grants provided to us by the NIH to improve perinatal care, neonatal care in the US as well as in developing countries.
Host: So, the networks are the Global Network of Women and Children's Health Research, the Neonatal Research Network and the Maternal Fetal Network. And as you mentioned, that brings in grant money for research in these areas. And I'm curious, as to being part of the neonatal research network, how that has opened up research opportunities. Could you let us know what that's done for your institution?
Dr Waldemar Carlo: Yes, it's very important. It has opened a lot of opportunities. For example, we conducted a very large study at Children's of Alabama in which we took babies that had bowel inflammation problems. And there are two treatments that have been used historically, and we found out which treatment was best for some babies and which treatment was best for the other babies. So, this is already been translated into practice, not just in Alabama, not just in the US, but all over the world.
Host: When you're working with the NIH, it has global implications which you're able to study. And I will tell you that being a pediatrician, I think that perinatology is one of the fields where what I learned about in medical school, what I learned about survival and treatment plans for babies back then has really changed to what it is today, the advancements have been outstanding. But those advancements takes a lot of dedication and research. Tell me a little bit more about some of the studies you've done because I've read your CV and it's pretty impressive.
Dr Waldemar Carlo: Yes. So for example, we did a study with necrotizing enterocolitis, that's the inflammation of the bowel that I mentioned. And there's two treatments, either opening the belly and doing a big surgery, it's called exploratory laparotomy, they open the belly and they explore; versus a tube to drain. And we did this multicenter randomized control trial, which is was the second one led by our team and our investigators, but this is the biggest one. And this definitely showed that there's some babies that do better with one treatment, and other babies do better with the other treatment. So, this was a major, major advancement. And likewise in developing countries, we did the study of keeping babies alive, babies who are born essentially dead, many babies are born that don't breathe, and we develop techniques and thought techniques to keep these babies alive with a reduction of mortality by more than 50%.
Host: Now, was that the First Breath Trial or is that something different?
Dr Waldemar Carlo: That's correct. That's the First Breath Trial. And in fact, it was named purposely because some babies do not take the first breath. We are used to seeing a baby born and then cry, and that's like a sign. Everyone knows if a baby's crying, he should be okay. Well, what about for the 10% of the babies that don't cry? They don't take that first breath. And that's where the First Breath Trial comes in and we resuscitated the babies and there was a big reduction in mortality.
Host: I also understand that you were part of the BRAIN-HIT trial. Was that something that happened at Children's of Alabama?
Dr Waldemar Carlo: Well, we did a study at Children's that is similar. So again, many babies, 10% of all babies are born, that they don't breathe, and we can resuscitate them. But some babies are born, don't breathe, but the heart has also stopped before being born. And those babies get special treatments like hypothermia, which we did at Children's Hospital and at University of Alabama at Birmingham. We did the randomized control trial that showed that hypothermia, so body cooling, improves their outcomes. They are healthier at two years of age.
Host: Which makes sense, right? I mean, if you think about it, we all know that when you have someone who's submerged or hypothermic, if they fall into a frozen lake, they actually have a longer time where you can really bring them back. So, it would make sense that if you're taking a hit to your brain, if your heart is stopping at the time of birth, if you can cool those babies down, you can sort of preserve things and give yourself a little bit more time to get things back up and running. Correct?
Dr Waldemar Carlo: You're totally right. That's the exact same thing. So, we cool the babies, it's a little bit more difficult to cool, because it's a cerebral control system, a system that maintains the baby's temperature at the exact temperature, so optimize the results and get really good outcomes. And we did that study at Children's and then we translated the study to do it in developing countries. It's slightly different techniques, but we followed the BRAIN-HIT. So, these babies had a hit, let's say. So, the BRAIN-HIT is actually an intervention, home-based intervention trial. These babies have taken a hit to the brain, but we treated them for three years in a randomized control trial to do early developmental intervention. This is very important, because we took babies with a brain hit and babies without a brain hit, but we put them all through a randomized trial of this early intervention. This is like brain games. It's a specific program of brain games, but this is something every parent can do in the US. And what we found is that the babies that had the BRAIN-HIT, they got five points more on the IQ and five more points on the motor development. And interestingly, the babies that didn't get a BRAIN-HIT also improved. So even the healthy babies born normally, they cried well, they also got a big benefit.
Host: Well, and that goes to the brain being so malleable, right, when you're born and that there's really so many connections and that, depending on what you expose the brain to, your brain sort of prunes itself to be able to work well in the environment that your brain thinks it's going to be in. Isn't that correct?
Dr Waldemar Carlo: That's correct. The brain is very malleable and there can be many improvements with early developmental intervention. And it's not just for sick babies, it's also for even the healthy, totally normal child.
Host: And just to give a plug in here, this is one of the reasons why as pediatricians, we don't love it when you put your baby, healthy or otherwise, in front of a screen for long periods of time because you are basically training the brain to do something different than it really needs to be doing, which is exploring its environment. So, it has real world implications, what you're talking about.
Dr Waldemar Carlo: It has. In fact, something we did is that the home-based intervention was all given by the parents. What we tried to do, because this is in low-income countries, we did not want to spend the money with healthcare workers. We taught the mothers and the fathers how to interact with the kid. And obviously, that did not include TV, but it included a curriculum of great interaction between the parent and the child.
Host: Well, that's so encouraging because, as you said, it is something that we're studying here but has global implications and when you can really have that type of scalability, it makes what we're doing all the more important. Because in developing countries, they do need our help to decrease their infant mortality rate. In summary, is there anything else you'd like to share with our listeners today?
Dr Waldemar Carlo: Yes, I'd like to say that it takes a village to raise a child. It takes everyone. If you're out there and you have a normal kid, you can help your kid, you can help other kids. And Children's Hospital is a great facility for children all over Alabama.
Host: I would a hundred percent agree with you. Thank you for being here with us and for this great discussion and sharing your expertise with us today. It was a pleasure to speak with you, Dr. Carlo.
Dr Waldemar Carlo: Thank you. Thank you very much.
Host: For more information or to refer patients to Children's of Alabama, visit childrensal.org. That concludes this episode of Children's of Alabama Peds Cast. If you found this podcast helpful, please share it on your social channels and be sure to check out the entire podcast library for other topics that might be of interest to you. Please remember to subscribe, rate, and review this podcast. Thanks for listening to this episode of Peds Cast. I'm your host, Dr. Cori Cross.
Neonatal Research Network, the Maternal Fetal Medicine Unit Network, and the Global Network
Dr Cori Cross (Host): Welcome to Peds Cast, a podcast brought to you by Children's of Alabama. I'm pediatrician, Dr. Cori Cross. Today, we'll be speaking with Dr. Wally Carlo. He is the Division Director of Neonatology at Children's Hospital of Alabama and at University of Alabama at Birmingham. He holds the Edwin M. Dixon Professor of Pediatrics Endowed Chair and is a world-renowned neonatologist. Thank you, Dr. Carlo, for joining us today.
Dr Waldemar Carlo: Thank you very much for having me here.
Host: So, tell us about the Neonatal Research Network. It's part of the NIH's Perinatal Network. Correct?
Dr Waldemar Carlo: It is correct. The Neonatal Research Network is one of the three NICHD Perinatal Networks. These are clinical networks to make major advances in perinatal care.
Host: And it's my understanding that Children's Hospital of Alabama is a member of all three of the NIH's perinatal networks, and that's a huge accomplishment. Isn't that correct?
Dr Waldemar Carlo: That's correct. We have now had for over 20 years the three networks. These are three major grants provided to us by the NIH to improve perinatal care, neonatal care in the US as well as in developing countries.
Host: So, the networks are the Global Network of Women and Children's Health Research, the Neonatal Research Network and the Maternal Fetal Network. And as you mentioned, that brings in grant money for research in these areas. And I'm curious, as to being part of the neonatal research network, how that has opened up research opportunities. Could you let us know what that's done for your institution?
Dr Waldemar Carlo: Yes, it's very important. It has opened a lot of opportunities. For example, we conducted a very large study at Children's of Alabama in which we took babies that had bowel inflammation problems. And there are two treatments that have been used historically, and we found out which treatment was best for some babies and which treatment was best for the other babies. So, this is already been translated into practice, not just in Alabama, not just in the US, but all over the world.
Host: When you're working with the NIH, it has global implications which you're able to study. And I will tell you that being a pediatrician, I think that perinatology is one of the fields where what I learned about in medical school, what I learned about survival and treatment plans for babies back then has really changed to what it is today, the advancements have been outstanding. But those advancements takes a lot of dedication and research. Tell me a little bit more about some of the studies you've done because I've read your CV and it's pretty impressive.
Dr Waldemar Carlo: Yes. So for example, we did a study with necrotizing enterocolitis, that's the inflammation of the bowel that I mentioned. And there's two treatments, either opening the belly and doing a big surgery, it's called exploratory laparotomy, they open the belly and they explore; versus a tube to drain. And we did this multicenter randomized control trial, which is was the second one led by our team and our investigators, but this is the biggest one. And this definitely showed that there's some babies that do better with one treatment, and other babies do better with the other treatment. So, this was a major, major advancement. And likewise in developing countries, we did the study of keeping babies alive, babies who are born essentially dead, many babies are born that don't breathe, and we develop techniques and thought techniques to keep these babies alive with a reduction of mortality by more than 50%.
Host: Now, was that the First Breath Trial or is that something different?
Dr Waldemar Carlo: That's correct. That's the First Breath Trial. And in fact, it was named purposely because some babies do not take the first breath. We are used to seeing a baby born and then cry, and that's like a sign. Everyone knows if a baby's crying, he should be okay. Well, what about for the 10% of the babies that don't cry? They don't take that first breath. And that's where the First Breath Trial comes in and we resuscitated the babies and there was a big reduction in mortality.
Host: I also understand that you were part of the BRAIN-HIT trial. Was that something that happened at Children's of Alabama?
Dr Waldemar Carlo: Well, we did a study at Children's that is similar. So again, many babies, 10% of all babies are born, that they don't breathe, and we can resuscitate them. But some babies are born, don't breathe, but the heart has also stopped before being born. And those babies get special treatments like hypothermia, which we did at Children's Hospital and at University of Alabama at Birmingham. We did the randomized control trial that showed that hypothermia, so body cooling, improves their outcomes. They are healthier at two years of age.
Host: Which makes sense, right? I mean, if you think about it, we all know that when you have someone who's submerged or hypothermic, if they fall into a frozen lake, they actually have a longer time where you can really bring them back. So, it would make sense that if you're taking a hit to your brain, if your heart is stopping at the time of birth, if you can cool those babies down, you can sort of preserve things and give yourself a little bit more time to get things back up and running. Correct?
Dr Waldemar Carlo: You're totally right. That's the exact same thing. So, we cool the babies, it's a little bit more difficult to cool, because it's a cerebral control system, a system that maintains the baby's temperature at the exact temperature, so optimize the results and get really good outcomes. And we did that study at Children's and then we translated the study to do it in developing countries. It's slightly different techniques, but we followed the BRAIN-HIT. So, these babies had a hit, let's say. So, the BRAIN-HIT is actually an intervention, home-based intervention trial. These babies have taken a hit to the brain, but we treated them for three years in a randomized control trial to do early developmental intervention. This is very important, because we took babies with a brain hit and babies without a brain hit, but we put them all through a randomized trial of this early intervention. This is like brain games. It's a specific program of brain games, but this is something every parent can do in the US. And what we found is that the babies that had the BRAIN-HIT, they got five points more on the IQ and five more points on the motor development. And interestingly, the babies that didn't get a BRAIN-HIT also improved. So even the healthy babies born normally, they cried well, they also got a big benefit.
Host: Well, and that goes to the brain being so malleable, right, when you're born and that there's really so many connections and that, depending on what you expose the brain to, your brain sort of prunes itself to be able to work well in the environment that your brain thinks it's going to be in. Isn't that correct?
Dr Waldemar Carlo: That's correct. The brain is very malleable and there can be many improvements with early developmental intervention. And it's not just for sick babies, it's also for even the healthy, totally normal child.
Host: And just to give a plug in here, this is one of the reasons why as pediatricians, we don't love it when you put your baby, healthy or otherwise, in front of a screen for long periods of time because you are basically training the brain to do something different than it really needs to be doing, which is exploring its environment. So, it has real world implications, what you're talking about.
Dr Waldemar Carlo: It has. In fact, something we did is that the home-based intervention was all given by the parents. What we tried to do, because this is in low-income countries, we did not want to spend the money with healthcare workers. We taught the mothers and the fathers how to interact with the kid. And obviously, that did not include TV, but it included a curriculum of great interaction between the parent and the child.
Host: Well, that's so encouraging because, as you said, it is something that we're studying here but has global implications and when you can really have that type of scalability, it makes what we're doing all the more important. Because in developing countries, they do need our help to decrease their infant mortality rate. In summary, is there anything else you'd like to share with our listeners today?
Dr Waldemar Carlo: Yes, I'd like to say that it takes a village to raise a child. It takes everyone. If you're out there and you have a normal kid, you can help your kid, you can help other kids. And Children's Hospital is a great facility for children all over Alabama.
Host: I would a hundred percent agree with you. Thank you for being here with us and for this great discussion and sharing your expertise with us today. It was a pleasure to speak with you, Dr. Carlo.
Dr Waldemar Carlo: Thank you. Thank you very much.
Host: For more information or to refer patients to Children's of Alabama, visit childrensal.org. That concludes this episode of Children's of Alabama Peds Cast. If you found this podcast helpful, please share it on your social channels and be sure to check out the entire podcast library for other topics that might be of interest to you. Please remember to subscribe, rate, and review this podcast. Thanks for listening to this episode of Peds Cast. I'm your host, Dr. Cori Cross.