The NICHD began to support the Collaborative Pediatric Critical Care Research Network (CPCCRN) in April 2005 as a national resource for studying the scientific bases of pediatric critical care medicine. The network was renewed in 2009 and is currently in its second operational cycle. As in the first cycle, awards were made in a competition announced in requests for applications (see http://grants.nih.gov/grants/guide/rfa-files/RFA-HD-08-025.html and http://grants.nih.gov/grants/guide/rfa-files/RFA-HD-08-027.html). The NICHD's Pediatric Trauma an Critical Illness Branch (PTCIB) supports the network.
The CPCCRN provides the infrastructure needed to pursue rigorous clinical trials and descriptive studies in pediatric critical care medicine. The Network aims to reduce morbidity and mortality from pediatric critical illness and injury by enhancing knowledge of the scientific bases of pediatric critical care practice. The NICHD intends for the CPCCRN to support a substantial range of research activities, reaching across traditional disciplinary lines and transcending customary thinking and organizational structures to achieve innovative research in the care of critically ill and injured children.
The Network currently includes eight collaborative clinical sites with large pediatric intensive care units (PICUs). The sites were selected for participation in the Network based on proposed scientific work, patient diversity, expertise of the investigative team, and concordance with NICHD programmatic and scientific objectives. A Data Coordinating Center at the University of Utah Health Sciences Center supports the Network by using cutting-edge informatics to manage the complexities of the emerging collaborative research.
The technology, therapeutic agents, and strategies for treatment and life support in childhood critical illness and injury have evolved rapidly during the last two decades. Children once thought to be beyond the reach of modern medicine now survive in large numbers in the multidisciplinary PICUs, often with longer-term morbidity and/or special health care needs. Mortality in U.S. PICUs has fallen precipitously. Survivors of childhood critical illness and injury are at risk for morbidity and disability. Although pediatric critical care practice has evolved rapidly, most of this development has occurred without the benefit of descriptive studies that might enable translational understanding of the pathophysiology of life-threatening illnesses and injuries in childhood. The risks and benefits of much of pediatric critical care practice remain unquantified and poorly understood, particularly in relationship to long-term outcomes.
The CPCCRN conducts controlled observation and objective evaluation of these practices, including new management and technology methodologies, in children with complex critical illness and injury. These data will help to balance prompt implementation of new technologies and treatments while effectively evaluating their safety, efficacy, cost/risk/benefit ratios, and effects on long-term outcomes for children and their families.
To date, studies have examined critical pertussis, critical asthma in fatal and near-fatal cohorts, use of nutritional strategies to minimize hospital-acquired infection, clinical decision support in mechanical ventilation, opiate tolerance, parental bereavement, and cortisol activity in septic shock. One example, the critical pertussis study, is discussed below.
Critical Pertussis Study
Despite high U.S. immunization coverage rates, pertussis continues to cause substantial morbidity and mortality in U.S. children, especially among very young infants (the median age of subjects is 47 days). The CPCCRN Critical Pertussis in U.S. Children: Severe Morbidity, Sequelae, and Mortality: A Prospective Cohort Study (PDF - 240 KB) is a prospective cohort project undertaken to characterize the acute course of pertussis critical illness in children. The project uses trans-federal partnerships and a unique research business plan to conduct enhanced passive and active surveillance of 33,000 PICU admissions annually. Study researchers collect detailed data on mortality, organ failure, level of support, disability, and the burden for families.
The CPCCRN Critical Pertussis Study is the largest prospective cohort ever assembled for scientific study and seeks evidence of associations between acute course characteristics, mortality, and long-term neurobehavioral outcomes for survivors and their families. The unique CPCCRN infrastructure has also led to a translational partnership with a basic science laboratory funded by the National Institute of General Medical Sciences to increase understanding of the genomic and biological contributions to this persistent and often lethal problem for children.
- Children's Hospital Los Angeles
- Children’s Hospital of Philadelphia
- Children’s National Medical Center (Washington, D.C.)
- Phoenix Children’s Hospital
- Seattle Children's Hospital
- University of Michigan, Ann Arbor
- University of Pittsburgh
- University of Utah Health Sciences Center (Data Coordinating Center)
- Wayne State University, Detroit