5 minute read
Breathing Easy
RESEARCH AIMS TO DECREASE LUNG INJURY IN PREMATURE BABIES WORLDWIDE
Written by Marie Dilg
Noah Hillman, MD, is a secondgeneration neonatologist. He grew up listening to his mother, one of the first neonatologists in the country, share stories about caring for babies and saving the tiniest of newborns. Now, it has become his mission.
Dr. Hillman, a SLUCare neonatologist and the Kevin C. Beckmann Endowed Chair of Neonatal Research at Saint Louis University School of Medicine, focuses on the treatment of premature and extremely premature infants at risk of lung injury. Kevin Beckmann, president of Trident Steel Corporation, who himself was born prematurely, generously funded the chair to help all children, especially the most vulnerable, not only to survive but to thrive.
“The gestational age of babies we can save is getting younger and younger,” says Dr. Hillman. “The problem is that the lungs and the brain are the most vulnerable to injury in these babies. I focus my attention on how we might avoid placing them on breathing machines and, if we cannot avoid that, what is the safest and quickest way to get them off the machines to avoid long-term lung injury.”
At birth, almost half of all premature and low birth weight babies require some type of breathing assistance, such as mechanical ventilation. In most cases, babies require brief assistance. Some babies, however, need breathing support for longer periods of time. This increases the risk of inflammation in the lungs, and babies can develop bronchopulmonary dysplasia (BPD), scarring inside the lungs that leads to breathing problems. Most babies recover from BPD, but those who do not can suffer from long-term breathing problems.
Dr. Hillman and his team at SSM Health Cardinal Glennon Children’s Hospital are working to limit the need for mechanical ventilation by using a gentler form of ventilation known as bubble continuous positive airway pressure (bCPAP). Much like a CPAP used by adults with sleep apnea, bCPAP is a noninvasive respiratory support treatment that uses heated, humidified gas to deliver pressure to premature infants with respiratory distress. The gas is delivered through flexible prongs placed in a baby’s nose. The bCPAP not only optimizes lung protection for babies, it also is less cumbersome than a ventilator and allows for more interaction between babies, their parents and care providers.
Some infants need more support than a bCPAP can provide and must be placed on a mechanical ventilator. Dr. Hillman and his team are exploring medications to help get these babies off the ventilators quickly and safely without injury to the lungs or brain.
In one of the largest studies of its kind, their research found that using a combination of surfactant and the corticosteroid budesonide decreased the severity of BPD in preterm babies and increased lung function. Their findings have resulted in best practice protocols for BPD treatment.
Dr. Hillman and his team also have published numerous articles on best practice protocols for bCPAP. They developed guidelines for its use when transporting babies from one hospital to another. And, in collaboration with World Pediatrics, a nonprofit organization that helps children in Central America and the Caribbean, SSM Health Cardinal Glennon neonatologists travel abroad to educate providers on caring for premature infants and using the bCPAP.
The Promise of Discovery
For Dr. Hillman, who splits his time between the neonatal intensive care unit (NICU) and his lab, the freedom his endowed chair affords him to conduct research is invaluable. “I enjoy looking at clinical data and telling stories that answer clinical questions people care about,” says Dr. Hillman, who also is associate dean of clinical research at Saint Louis University School of Medicine. “I enjoy taking care of babies, but with research you have the potential to help millions of babies throughout the world. Advancing knowledge about what we should be doing to prevent lung injury is extremely rewarding.”
Dr. Hillman says his research would not be possible without the support he and his fellow researchers receive from private donors and the SSM Health Cardinal Glennon Children’s Foundation. The foundation pays for the data analyst who conducts deep dives into medical records. This data is crucial for identifying research paths. Dr. Hillman says the foundation also funded the purchase of a highfrequency oscillatory ventilation machine to treat the sickest of newborns. Funds from the endowed chair have allowed him to develop new BPD models to test the effects of steroids on the developing brain and explore different types of bCPAP devices. The support also allows for mentorship of neonatal fellows and the development of research projects by other faculty within the Division of Neonatology.
In its 2024-2025 list of the best hospitals and specialty departments around the country, U.S. News & World Report ranked the NICU at Cardinal Glennon Children’s Hospital as one of the top NICUs in the country. It is the fifth consecutive year the NICU has been recognized with this honor. “It’s great to be recognized for the work the division has been doing and the support we receive to advance neonatal research,” says Dr. Hillman. “That is the beauty of Cardinal Glennon. We are big enough to offer top-notch care and cutting-edge research but still small enough to provide that personal touch.”
