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Dr. Konduri’s research focuses on pulmonary circulation in the fetus and newborn. |
A baby inside the womb receives its oxygen supply directly from the umbilical cord. Outside the womb, a critical transition must take place as the infant independently takes in oxygen during the first 30 seconds after birth. Most infants take their first breaths rather easily thanks to the body’s natural chemical reactions, but infants with pulmonary hypertension may require special assistance.
Girija Ganesh Konduri, MD, associate professor of pediatrics, has found a way to provide therapeutic assistance through his extensive research on the respiration process. "As part of my patient care, I developed an interest in why certain babies have problems initiating breathing," said Dr. Konduri. "My research has focused on how changes occur in the lungs to get a baby ready for its first independent breath. In children with respiratory problems, I’m trying to determine how and why the process gets disturbed."
When oxygen enters the lungs, blood flow increases. If there is a shortage or depletion of oxygen, pressure can build up, causing pulmonary hypertension, which is evidenced by constricted blood vessels and high blood pressure in the lungs.
Dr. Konduri discovered that ATP, the energy-providing substrate in cells, is responsible for stimulating the production of nitric oxide. This nitric oxide, in turn, relaxes the vessels and facilitates the steady flow of blood and oxygen. "When you look at a blood vessel, you see red blood cells in the middle, an endothelium lining, and muscle wrapped around the vessel. ATP works on the lining to produce nitric oxide which relaxes the muscle," said Dr. Konduri.
After documenting and understanding this process, Dr. Konduri and his researchers began to examine the differences between infants who did and did not have pulmonary hypertension. They found that babies with pulmonary hypertension have a defective gene and therefore, decreased nitric oxide production.
He is currently leading a clinical trial, which makes Wayne State University and The Detroit Medical Center one of 23 sites in the country to provide nitric oxide to infants who display respiratory failure very early. Dr. Konduri led a similar trial a few years ago, which found nitric oxide to be successful in treating critically ill babies. Now the goal is to identify and treat these children even earlier.
"The great thing about newborns is that they are still in the developing stages," said Dr. Konduri. "If we identify the respiratory problem and treat it within the first two weeks, we can generally stimulate the natural production of nitric oxide and the body will begin to make its own in sufficient quantities. If we do our job, the babies’ lungs will take care of themselves."
Dr. Konduri published an article on nitric oxide synthesis in babies with pulmonary hypertension in the September 1998 issue of Pediatric Research and he recently received nearly $800,000 from the National Institutes of Health to study pulmonary circulation in the fetus and newborn.