Un nuevo estudio publicado en Journal of Perinatology, está ayudando a evitar las transfusiones de sangre en bebés prematuros gracias a una nueva investigación y colaboración entre investigadores de Intermountain Health y University of Utah.

Timothy Bahr, MD, neonatólogo e investigador clínico de Intermountain Health, colaboró con Robert Christensen, MD, y Robin Ohls, MD, de University of Utah Health, a explorar la dosis y frecuencia necesarias de una medicación llamada darbepoetina (darbe), la cual estimula la producción de glóbulos rojos en bebés prematuros.

Los bebés prematuros a menudo sufren de niveles de glóbulos rojos bajos (anemia), lo cual puede contribuir a varias complicaciones tales como el retraso en el desarrollo y la dificultad para respirar.

Se han utilizado inyecciones subcutáneas de darbe para tratar, de manera eficaz, la anemia causada por nacimiento prematuro y estimular la producción de glóbulos rojos en bebés prematuros, para así reducir la necesidad de transfusiones de glóbulos rojos en Estados Unidos en los últimos 20 años.

El objetivo del estudio fue refinar la dosis y frecuencia de darbe en estos bebés vulnerables, para brindar beneficios de salud óptimos, junto con el número menor de inyecciones subcutáneas necesarias.

El Dr. Bahr y sus colaboradores, quienes han estado al frente de la investigación en el tratamiento de anemia en bebés prematuros, condujeron su estudio en Intermountain Medical Center en Murray y en Intermountain Valley Hospital en Provo.

El estudio analizó dos horarios de dosis diferentes: inyecciones una vez a la semana, y una cada dos semanas.

Los resultados fueron prometedores.

“Encontramos que, mientras las dosis semanales de darbe incrementaban la producción de glóbulos rojos levemente, ambos horarios resultaron similares en cuanto a beneficios para la salud en los bebés”, dijo el Dr. Bahr. “Esto significa que administrar Darbe cada dos semanas sería una opción viable, reduciendo así el número de inyecciones que estos bebés necesiten”.

“Administrar menos inyecciones puede resultar en una experiencia más llevadera para los bebés prematuros y sus padres, y también podría, potencialmente, disminuir los gastos farmacéuticos y de atención médica”, añadió.

De acuerdo con neonatólogos, cuando darbe aumenta los niveles de glóbulos rojos a niveles más normales en bebés prematuros, estos tienen una menor probabilidad de necesitar transfusiones de sangre.

Algunos bebés prematuros solo necesitan inyecciones de darbe, mientras que otros pacientes recién nacidos en estado más crítico también pueden llegar a necesitar una transfusión de sangre para ayudarles a mejorar sus probabilidades de supervivencia en la unidad de la UCI neonatal.

“Las transfusiones de sangre se pueden realizar de manera segura y pueden salvar la vida de bebés prematuros, pero conllevan ciertos riesgos. Si podemos reducir la necesidad de transfusiones de sangre en bebés prematuros, también podemos reducir el riesgo de complicaciones que pueden suceder después de una transfusión de sangre”, dijo el Dr. Bahr.

Según el Dr. Bahr, la tasa de transfusiones de sangre en bebés prematuros en las unidades UCI neonatales de Intermountain Health está bastante por debajo del promedio nacional.

Durante los últimos 20 años, Intermountain ha utilizado darbe y ha continuado su investigación para hallar las mejores prácticas para esta medicación, lo cual es parte del esfuerzo en reducir el número de transfusiones necesarias en bebés prematuros.

“La eliminación de transfusiones de sangre innecesarias en Intermountain Health o la ‘responsabilidad con las transfusiones’, es muy parecida a nuestros esfuerzos en cuanto a la responsabilidad con los antibióticos, la cual promueve el uso responsable de antibióticos y reduce el uso innecesario y mejora la atención del paciente y los resultados”, dijo el Dr. Bahr.

“Los resultados de este estudio de investigación ofrecen un enfoque potencialmente nuevo en la administración de darbepoetina a bebés prematuros, proporcionando un equilibrio entre el tratamiento efectivo y el beneficio de realizar menos intervenciones médicas”, dijo Elizabeth O’Brien, MD, directora médica principal de la salud neonatal en Intermountain Health. “Esta es una de las muchas maneras en las que Intermountain está trabajando para mejorar la salud y el bienestar de los bebés prematuros y brinda una atención más avanzada y compasiva para estos pacientes tan pequeños y vulnerables”.

Intermountain Primary Children´s Hospital tiene la UCI neonatal de nivel IV más destacada en la zona Mountain West, e Intermountain tiene otros 17 hospitales adicionales (10 en Utah) con unidades UCI neonatales.

Los profesionales de la salud de los 20 hospitales de Intermountain Health que tienen unidades de parto en Utah, tienen acceso a interconsultas con neonatólogos virtuales las 24 horas del día, siete días a la semana. Intermountain Health está nacionalmente reconocido por la habilidad única de ofrecer telemedicina neonatal de alto nivel a hospitales rurales.

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 An Intermountain Health physician who has played a key role in advancing women’s health was among a select group of women’s health advocates and experts invited to the White House to celebrate the first-ever White House Initiative on Women’s Health Research, which is working to improve women’s health across the country.

Last week, President Joe Biden and First Lady, Dr. Jill Biden, invited a select group of women’s health advocates, clinicians, researchers, experts, investors and philanthropists to the White House for a conference to celebrate the program’s success.

Intermountain Health’s senior medical director of women’s health for Utah and Idaho, Audrey Jiricko, MD, was among them. 

Dr. Jiricko has played a key role in advancing women’s health at Intermountain Health. As an obstetrician-gynecologist, she has helped activate intimate partner violence screening and pioneer the integration of mental health screening in the OB-GYN setting.

Aside from improving patients’ health and safety, these practices recognize the holistic scope of women’s health issues and challenges.  

“We’re not only able to connect patients to resources, but also to find links between a history of traumatic stress and other health conditions like chronic pelvic pain,” said Dr. Jiricko. “It helps us look at each patient as a whole person.” 

That’s an ethos Dr. Jiricko has brought to her whole career.

She’s collaborated across disciplines to promote best practices in women’s health, recently leading the creation of Intermountain Health’s first Women’s Heart Health Program.  

Heart disease is the number one killer of women nationally, but women’s heart research lags behind research specific to men – as does women’s heart care. Statistically, across the nation, women who complain about chest pain wait longer to receive an EKG than men, and women who suffer heart attacks wait longer than men for intervention. 

Hypertensive disorders of pregnancy – which include chronic or gestational high blood pressure, and the more serious preeclampsia and eclampsia – can affect the health of the mother and baby during pregnancy, and can also impact their long-term cardiovascular health.

Dr. Jiricko is working with an Intermountain cardiovascular research team to review health records from more than 200,000 Intermountain patients who’ve had hypertensive disorders during pregnancy.

The goal is to map what Intermountain can do as a health system to implement proactive care and prevent negative outcomes, including outpatient and in-home blood pressure monitoring during pregnancy and long-term follow-up afterward.  

“We have so much data,” said Dr. Jiricko. “We support more than 40,000 deliveries per year. It’s an exciting opportunity.” 

It’s all work that embodied the spirit of the White House Initiative on Women’s Health, which President Biden said at the event is intended to “fundamentally change and improve how we invest in women’s health.” For Dr. Jiricko, it was a reminder that the work she’s led and continues to lead at Intermountain really does make a difference. 

The Initiative is leading the way by allocating nearly $1 billion in funding from a variety of federal agencies to improve women’s health across the country.

“Every time I attend a national event like this, I appreciate Intermountain Health even more,” she said. “We’re doing great research, but we’re also operationalizing those best practices to deliver excellent care to our patients. Our focus on becoming a model health system brings it all together.” 

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Cardiac researchers at Intermountain Health have received a $2.4 million, four-year federal grant from the National Institutes of Health to study ways to enhance care for the millions of Americans who suffer from a common, and potentially fatal, heart condition.

Intermountain Health heart researchers will use the NIH grant to study ways to enhance monitoring and treatment for patients who experience mitral valve prolapse, a condition that occurs when the heart’s mitral valve leaflets don't close properly, allowing blood to leak backward into the left atrium.

Mitral valve prolapse affects between 2% and 3% of the general population, which is roughly 7.8 million people in the United States and more than 176 million people worldwide. 

Symptoms of mitral valve prolapse may include a racing heartbeat, dizziness, shortness of breath, fatigue, and chest pain. However, for many patients, mitral valve prolapse doesn't cause any symptoms. 

Many mitral valve prolapse patients live with the heart condition their whole lives without it ever affecting their health. In other people, it can lead to additional heart disease, such as heart failure or arrhythmias, and even death.

“This study will allow us to evaluate more precisely who is going to develop moderate to severe MVP and moderate to severe-related health problems,” said Benjamin Horne, PhD, principal investigator of the study and director of cardiovascular and genetic epidemiology at Intermountain Health. “We will be more aware of someone potentially needing more intense therapy or more frequent follow up and follow them to ensure that their health is being maintained.”

When a mitral valve prolapses, the valve between the heart’s upper and lower chambers doesn’t close properly. The main complication of mitral valve prolapse is mitral regurgitation, where blood leaks backwards, and therefore doesn’t efficiently deliver oxygen throughout the body.

Mitral valve prolapse is one of the most common causes of mitral regurgitation. If the leak is severe enough, a person may need surgery to repair or replace the valve.

Heart valve regurgitation is common globally. In the United States, mitral valve regurgitation is the most common form of heart valve disease.

“As cardiologists, we are quite accustomed to diagnosing and managing mitral valve prolapse associated mitral regurgitation,” said Brian Whisenant, MD, structural heart cardiologist at Intermountain Health and co-investigator of this study. “However, by focusing on leaking values we are certainly ignoring most of the iceberg. This study looks at that whole iceberg, not just the tip.”

Through this grant, Intermountain researchers will retroactively evaluate the electronic health records of tens of thousands of Intermountain patients, going back to the 1990s.They will identify people who have been diagnosed with mitral valve prolapse, which is typically done through an echocardiogram, and follow their outcomes.

The Intermountain study will allow researchers to identify factors that could predict whether mitral valve prolapse affected a patient, and what is most common in those with poor outcomes.

Mitral valve prolapse can be caused by several heritable factors and is associated with a variety of diseases including connective tissue disorders, Graves' disease, scoliosis, von Willebrand syndrome, and muscular dystrophy. 

Intermountain researchers will work with Intermountain’s HerediGene: Population Study  to identify genetic markers for mitral valve prolapse, and Intermountain’s genealogy registry to identify families in whom mitral valve prolapse is common.

Overall, Intermountain researchers hope to create a score that will allow physicians to, upon diagnosing mitral valve prolapse, determine if “this is really going to be benign or is this something they should start considering right now when they don’t have the health problems that can arise from it,” said Dr. Horne.

For example, if someone scores high, they can be better tracked and monitored and know that surgery might be necessary in the future, Dr. Horne added.

“This study will help doctors know when mitral valve prolapse is a clue that warrants further investigation and when patients can be reassured,” said Dr. Whisenant. “In some ways, it’s like asking a dermatologist if a spot is anything to worry about. Most spots are freckles, but some are cancer. We hope this study will help us develop methods to better make that determination for patients with mitral valve prolapse.”

The grant is supported by the National Heart, Lung, And Blood Institute of the National Institutes of Health under Award Number R01HL172982. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

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