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As a student at the University of Rochester School of Medicine, Judy Aschner had trouble choosing a specialty. She liked all her clinical rotations and the full spectrum of medical subspecialties as well. “Then I walked into the neonatal intensive care unit and realized I had found my place in medicine,” she says. “Neonatologists in a way are generalists for newborns. We take care of infants with heart disease, lung disease, infections, brain injury, congenital anomalies.…”
Dr. Aschner came to Einstein from Vanderbilt University School of Medicine, where she built a nationally recognized neonatology program. For the last year she has offered her talent and experience to the Bronx pediatric community—with a special place in her heart for the problems of preterm birth.
In 1987, while she was pregnant with her third child, her membranes ruptured at 21 weeks—a serious threat to her unborn child’s life. Although bed rest helped her extend the pregnancy to 31 weeks, her son, Nadav, was born premature and very sick.
Fortunately, the use of surfactant replacement therapy—an investigational drug at the time—helped him breathe by lowering the surface tension in his lungs. Nadav is now 26 and recently graduated from law school.
Despite this happy outcome, Dr. Aschner and her husband, Michael Aschner, Ph.D., now a professor and Harold & Muriel Block Chair in Molecular Pharmacology at Einstein, learned firsthand how parents feel when facing crucially important decisions affecting their child’s care. Under her direction, the parents of all children treated at The Children’s Hospital at Montefiore are fully informed members of the decision-making team.
Just as her son benefited from an innovative therapy, Dr. Aschner’s tiny patients are helped by her commitment to offering them the latest biomedical advances—including her own.
One of her main interests is pulmonary hypertension (high blood pressure in the lungs). “In utero, the blood pressure in the lungs is normally very high but must fall dramatically at birth so that the newborn can take in oxygen and survive outside the womb,” she explains. “That process doesn’t always go well, especially for infants who have infections or lung or heart disease.”
Inhaled nitric oxide therapy, which dilates blood vessels, has transformed the field of neonatology, saving the lives of many full-term babies who would otherwise have died from pulmonary hypertension. “But many premature infants,” she says, “develop a devastating form of pulmonary hypertension that doesn’t respond to nitric oxide gas, so other strategies are needed.”
In the lungs and elsewhere in the body, cells lining blood vessels make their own nitric oxide, from amino acids synthesized in their intestine or provided by their diet. Dr. Aschner believes that premature infants cannot make enough of these amino acids and may not receive sufficient amounts in their diet. She has studied two animal models of pulmonary hypertension to see if giving them these amino acids might help them synthesize nitric oxide.
“We’re really excited by our results,” she says. “We’ve published several papers showing that one amino acid can reverse pulmonary hypertension and the arrested lung development associated with preterm birth.”
Dr. Aschner is also principal investigator on a National Heart, Lung and Blood Institute–funded multicenter study to identify biomarkers that predict which extremely preterm infants will develop long-term respiratory illness. “This work should help us better target therapies so we give the right medicine to the right baby at the right time,” she says.