Preterm Respiratory Oxygen Toxicity and Optimized Environmental Care and Treatment/Therapies
Home / Studies / protect


Preterm Respiratory Oxygen 
oxicity and Optimized 
nvironmental Care and Treatment/Therapies

In Project PROTECT, we use cutting-edge imaging to monitor early brain development to pick up early signs if it veers off track. We will examine how neurodevelopment is linked to optimal neonatal intensive care unit (NICU) care for infants born extremely premature, as well keep track of these babies to see how they fare years after NICU discharge. About 1 in 10 U.S. infants is born preterm, and an estimated 63,000 infants per year are born weighing less than 1,500 grams – some small enough to fit inside their parent’s palm. Prematurity is strongly associated with neuropsychological disability, but the first signs of brain injuries can be subtle and silent. We hope our findings guide future NICU interventions to lessen disabilities among the most vulnerable newborns.

Contact us to join Project PROTECT
+1 202.476.3842

We hope that the findings from Project PROTECT guide future NICU interventions to lessen disabilities experienced by the tiniest, most vulnerable newborns


Project PROTECT (Preterm Respiratory Oxygen Toxicity and Optimized Environmental Care and Treatment/Therapies) aims to help the smallest, sickest infants who are at the highest risk for developing brain injury. More than 50% of newborns who survive preterm birth have cognitive deficits. That’s three times the rate of infants who are born full term. Our study team will use sophisticated, advanced imaging and one of the world’s largest databases of fetal and neonatal brain images from uncomplicated pregnancies to identify potent risk factors for brain injury. These risk factors can include how sick the newborns are, how long they rely on supplemental oxygen as well as the degree of anxiety, stress and depression their mothers feel during pregnancy. Project PROTECT has the potential to revolutionize how we care for tiny, vulnerable newborns. 

What should I expect?

From the time your newborn is admitted to our NICU to when he/she is a toddler, both of you will participate in several surveys and tests that let us know about key events during pregnancy, birth, stay in the NICU and the first 2 years of your child’s growth that may have impacted your child’s overall development. The surveys will help us understand how you feel as a new mom. We will time many of these activities to coincide with when we take safe, advanced images and readings that track how your baby’s brain is developing.

When your baby is admitted to our NICU, we’ll collect a saliva sample from mom, and you will complete surveys that measure what you ate during pregnancy and gauge your emotions as a new mom. Mom and babies who are able will have skin-to-skin contact to see how touch affects heart rate. Your baby will undergo his or her first postnatal magnetic resonance imaging (MRI) session as well as a test that measures how brain cells communicate, and he or she will contribute a blood sample and DNA swab.

Every four weeks - depending on his/her gestational age at birth and overall health - your newborn may undergo more brain imaging scans with additional activities timed to coincide with each imaging session. (So, a baby born at 24 weeks gestation would have a total of five MRIs and five biospecimen collections, and moms would complete surveys each time. Babies born closer to term would have as few as two MRIs.)

Around the time you originally had been scheduled to give birth, moms will provide another saliva sample and will complete surveys that gauge emotional well-being. Your baby will undergo his or her final postnatal MRI as well as a final test to measure how brain cells communicate (EEG). He or she will contribute a blood sample and DNA swab and will undergo a bedside assessment of motor skills, cognition and behavior.

We’ll check in with moms by telephone to discuss how your baby is doing about the time your baby turns 6 months and 1 year (corrected term equivalent). Finally, when your baby turns 18 months (corrected age) we’ll send moms surveys by mail that measure anxiety, depression, stress and resilience. Toddlers will provide their final DNA sample and will undergo comprehensive tests of speech, motor skills and developmental progress during an in-person visit.
Who can participate?
Preterm infants who

• Are born younger than 36 weeks gestation

• Have birthweights appropriate for their gestational age

• Are admitted to the Children’s National NICU within 72 hours of birth
Who may not participate?
Preterm infants with

• Evidence of major brain injury

• Dysmorphic features

• Congenital anomalies arising from a confirmed genetic or metabolic syndrome or congenital infection
Will I be paid?
Pregnant women:

Eligible Project PROTECT study participants will receive a $25 ClinCard at each outpatient visit and each neurodevelopmental visit – and parking vouchers for study-related visits to the Children’s National main campus.