Neurocritical Care Research Networks—Pediatric Considerations

Abstract

To The Editor: We read the series of articles in the most recent edition of Neurocritical Care with great interest [1–3] regarding the utility of research networks for critical illnesses. We appreciate that specialized research networks for patients with critical neurological conditions are needed to advance the field, and we share the author’s view that collaborative efforts of a large number of individuals and institutions are essential to muster the forces necessary to carry out truly groundbreaking studies. We also believe that such studies must be properly designed, conducted, supported, and reported within the literature. However, we were disappointed that the contribution of pediatrics to the history of such networks, both funded through traditional sources and formed on an ad hoc basis, was omitted from the series of articles. One of the earliest examples of collaborative efforts in life-threatening diseases stems from the Children’s Oncology Group (COG). Founded in 1955, this group (now including 200 institutions and 7,500 collaborating investigators) has made major advances in decreasing the mortality rates from cancers of childhood [4, 5]. In 1986, the Eunice Kennedy Shriver National Institute of Child Health and Human Development initiated the Neonatal Research Network to conduct studies that would improve the health of newborn infants. Among other studies, this network has successfully determined that hypothermia is neuroprotective for children who suffer from perinatal asphyxia—leading to a global change in standards of care across the country [6–8]. In 2001, the Emergency Medical Services for Children Program awarded cooperative agreements to fund the Pediatric Emergency Care Applied Research Network (PECARN) to conduct multi-institutional research in the management of acute illnesses of children. One of their most influential studies to date involved the determination of a decision-rule for obtaining neurological imaging in children after traumatic brain injury (TBI) [9], and they continue to investigate the utility of progesterone after TBI and hypothermia after cardiac arrest. Most recently, the Collaborative Pediatric Critical Care Research Network (CPCCRN) was formed in 2005. This network, consisting of seven clinical sites, has established new outcome assessment tools for children after critical illness (the Functional Status Score) [10] and is actively working with PECARN to complete the therapeutic hypothermia after pediatric cardiac arrest (THAPCA) trials among other initiatives. In addition to these federally funded networks, several investigator-initiated networks have made significant contributions. As mentioned in the current report, the Canadian M. J. Bell (&) PNCRG, University of Pittsburgh, Pittsburgh, PA, USA e-mail: bellmj4@upmc.edu