Faculty Profile: Betty Vohr, MD

Betty Vohr, MD
Professor of Pediatrics
Pediatrics
Work: +1 401-274-1122-x47435
Betty Vohr, M.D., has been conducting outcome studies and trials of interventions to improve the outcomes of high risk infants, including premature infants, infants of gestational diabetic mothers, and infants with permanent hearing loss for the past 30 years. Dr. Vohr has been the principal investigator of the National Institute of Child Health and Development Neonatal Research outcome studies of the Network since 1995.

Biography

Betty R. Vohr, MD "The Investigation of the Neurodevelopmental, Behavioral, and Growth Status of High Risk Populations of Infants" Our research interests are focused on clinical longitudinal studies of high risk populations. The Neonatal Follow-up Program provides longitudinal assessments and management of high risk extremely low birth weight and moderately low birth weight infants. We are the Coordinating Center for NICHD NRN studies of neurologic and developmental outcome. A second area of investigation is the identification and outcome of infants with hearing impairment. We are investigating language and behavior outcomes of children with hearing loss. A third funded study, Partnering with Parents, The Medical Home and Community Partners provides enhanced transition services to all high risk RI infants < 37 weeks who require ≥ 5 days the NICU. This CMMI study is funded for a 3 year period to improve care, improve outcomes and reduce costs.

Institutions

Wih

Research Description

The goal of the Language and Behavioral Outcomes of Children with Congenital Hearing Loss: Family Perspective Study II project is to prospectively examine the language, communication, behavior and adaptive skills of early identified children with minimal (unilateral or bilateral < 40 dB) hearing loss (Min HL) and children with moderate-to-profound bilateral (≥ 40 dB) hearing loss (Mod HL) compared to typically hearing children at 24, 36, and 48 months, and to identify the child, family, and intervention characteristics which contribute to optimized outcomes. This is a continuation of comprehensive evaluation of this cohort at 6, 12, and 18 months of age. There is increasing evidence that unilateral and mild/minimal hearing loss < 40 dB impact negatively on academic and language outcomes at school age. The school age outcome data on mild and unilateral HL is important on two counts. First, current screening protocols based on a target threshold of 40 dB may not identify these infants, and second, in some states even if identified, these infants are not eligible for intervention services. There is no data available on the outcomes of early identified infants with Min HL. We have been evaluating prospectively a cohort of children with Min HL, Mod HL, and typically hearing controls at 6, 12, and 18 months of age. In this continuation we will complete comprehensive evaluations at 24, 36, and 48 months. The specific aims are: 1) to assess the longitudinal development of receptive and expressive language, behavior, and adaptive skills; 2) to evaluate effects of the onset and frequency/quality of participation of early intervention (EI) on child language, behavior, and adaptive skills; 3) to evaluate the communicative effectiveness of mother-child dyads and assess its relationship with child receptive and expressive language, behavior, and adaptive skills; and 4) to evaluate the effects of maternal environmental factors and child factors (degree of HL, entry to Early Intervention, co-morbidities) on child outcomes. The three primary hypotheses are: 1) children with bilateral moderate-to-profound HL (Mod HL) will have lower language, adaptive scores than children with unilateral or mild bilateral HL (Min HL) and children with typical hearing; 2) language and behavior scores of children with Min HL will diverge from those of typically hearing children with increasing age; and 3) children with both Min and Mod HL enrolled in EI ≤ 3 months, and whose parents have frequent and positive experiences in EI, will have better language, behavior, and adaptive skill development than those enrolled after 3 months of age.

Intraventricular hemorrhage (IVH) or hemorrhage into the germinal matrix tissues of the developing brain, results in significant neurodevelopmental handicap. Our multicenter, randomized, placebo-controlled trial demonstrated that indomethacin significantly lowered the evidence and decreased the severity of IVH in those very low birth weight (VLBW) preterm infants with no evidence for IVH at 6 to 12 postnatal hours, our primary analysis population. A secondary trial conducted at the same time showed no effect of indomethacin for the prevention of existing IVH. Indomethacin has recently been demonstrated to have gender-mediated effects. Although a gender-by-indomethacin effect was not an a priori hypothesis of the application, reanalysis of our data demonstrated that the indomethacin-IVH effect occurred exclusively in male infants. Children randomized to indomethacin had better long-term survival, and male indomethacin subjects exhibited better verbal testing scores during their early grade school years than male placebo children, suggesting this neonatal intervention may produce a long-lasting effect on developmental skills in VLBW preterm infants.

The purpose of the study is to understand the learning abilities of children born prematurely who have been participating in our multicenter trial to reduce the incidence of brain hemorrhage in preterm infants. Previous assessments were done at 3, 4-1/2, 6, 8, and for some children at 12 years of age.

A neurological, developmental, behavioral, and attention assessment will be completed at 12 years and 16 years. The neurological assessment evaluates coordination and reflexes. The developmental assessment evaluates language, overall knowledge, perception, attention, memory skills, reading, and mathematics. A psychometrist will administer the tests, and a developmental pediatrician will do the neurological. Most tests are similar to those done at the previous visit. The developmental tests will take 120-180 minutes and the neurological exam will take about 30 minutes. The mother will complete questionnaires about her child's behavior, which will take about 60 minutes. Speech language testing will take 60 to 90 minutes.

The proposal is a reapplication from the Brown Medical School to participate in the Cooperative Multi-Center Neonatal Research Network (RFA-HD-04-010). Abbot Laptook, M.D., will serve as the Principle Investigator, the Co-Investigator (Alternate) will be William Oh, M.D., and the Follow-up Investigator will be Betty Vohr, M.D. The primary teaching hospital of Brown for this proposal is Women and Infants' Hospital of Rhode Island (WIHRI). The Neonatal Intensive Care Unit (NICU) of WIHRI has a 60+ bed capacity and serves as the sole level III NICU in Southeastern New England. Adjoining WIHRI is Hasbro Children's Hospital, which provides all needed specialized pediatric services for radiologic, surgical, and other subspecialty services. There are a number of considerations that justify Brown as one of the sites for the Network. First, Brown is the sole regional provider of perinatal services in Southeastern New England and thus provides a population that represents a geographic region. The stability of the number of deliveries, number of infants with a birth weight < 1500 grams, and referrals of high-risk pregnancies demonstrate a well-organized regional perinatal care system with established referral lines among the obstetric and pediatric communities. Second, the Brown site has a proven record within the Network. It has been a member institution since 1991 and continues to have a well-organized research team with a high percent of eligible infants enrolled in randomized trials, limited errors in conducting studies, complete data acquisition, and an almost 90% follow-up rate. Third, the Brown site has an outstanding trio of investigators in Drs. Laptook, Oh, and Vohr, who are experienced in clinical research and provide expertise in multiple areas critical for the success of the Network. Finally, the Division of Neonatal-Perinatal Medicine at Brown has a strong commitment to clinical research. This commitment is reflected among the NICU staff at WIHRI who have come to expect patient participation in clinical research. The Brown site and WIHRI has made many important contributions to advance perinatal care over the last 30 years both as a single institution and in collaboration with other academic centers. Participation in the Neonatal Research Network provides the ideal forum to perform interventional and observational studies of neonates, and achieve a divisional and institutional goal to advance neonatal care though rigorous research and evidenced based medicine.

Grants and Awards

1994 -- Marion Downs Award: Presented for outstanding contribution to the field of pediatric audiology by the Academy of Audiology at the March meeting in Richmond, VA.

1995 -- Best of 1995 the Hearing Journal All-Around-Favorite Award for the manuscript "Referral Rates and Cost Efficiency in a Universal Newborn Hearing Screening Program using Transient Evoked Otoacoustic Emissions JAAA 6:271-277(1995).

1997 -- Ford Foundation award to Rhode Island Hearing Assessment Program of $20,000 as semi-finalist in "Innovations In Government" competition.

1999 -- Rhode Island Medical Women's Association - "Woman Physician of the Year"

2000 -- Ear and Hearing Editor's Award for Outstanding Research in Audiology and the Hearing Sciences from the American Audiology Society

2001 -- Recipient of the Braden Griffin, M.D. Memorial Lectureship Award, University of Massachusetts Memorial Hospital

2003 -- Healthy Mothers, Healthy Babies 2003 Silver Rattle Award from Rhode Island March of Dimes

2004 -- Public and Community Health Award of the March of Dimes Rhode Island Chapter 2004 Jonas Salk Leadership Awards

2008 -- Nominated for the Antonia Brancia Maxon Award for Early Hearing Detection and Intervention (EHDI) Excellence presented at the National EHDI Conference. Received an award for nomination.

2010 -- Marion Downs Ambassador Award for "Promoting the Vision of Early Identification, Intervention, and Family Support for Hearing Loss to the Pediatric Community" at the March Marion Downs Symposium in Denver, Colorado.

2011 -- Antonia Brancia Maxon Award for Early Hearing Detection and Intervention (EHDI) Excellence at the National EHDI Conference in Denver, CO.

2012 -- Recipient of the Women's Leadership Award from the Ronald McDonald House of Providence presented at their Annual Awards Ceremony held on September 27th.

2013 -- SPR Douglas K. Richardson Award presented at PAS Annual Meeting, Washington, DC on May 5th

Affiliations

1971-present Bristol County Medical Society
1971-present RI Medical Society
1972-present American Academy of Pediatrics
1974-present RI Pediatric Society
1974-present New England Pediatric Society
1976-present Ambulatory Pediatric Association
1979-present American Academy for Cerebral Palsy and Developmental Medicine
1983-1996 Society for Developmental and Behavioral Pediatrics
1983-present International Society for the Study of Behavioral Development
1984-present Section on Child Development of the American Academy of Pediatrics
1985-present Society for Pediatric Research
1994-present American Pediatric Society, Society for Research in Child Development
1995-present American Diabetes Association
1995-present Fellow of the American Academy Audiology
1997-present National Perinatal Association

Funded Research

ACTIVE GRANTS:

NIH/NINDS (Co-Investigator) R01, 4/1/2005 to 3/31/2010 ($460,385—Years 16 to 20)
"Randomized Indomethacin GMH/IVH Prevention Trial"

NICHD (Co-PI) 4/1/2006 to 3/31/2011 ($815,971—Years 10 to 15)
"Multicenter Network of Neonatal Intensive Care Units Follow-up Coordination"

Rhode Island Department of Health (PI), 10/1/2005 to 9/30/2006 ($209,000—Year 13)
"Rhode Island Hearing Assessment Program"

CDC-EHDI, (PI) UR3, 8/1/2001 to 8/31/2006 ($891,984)
"Cooperative Agreement for Early Hearing Detection and Intervention"

CDC-EHDI, (PI) UR3, 7/1/2005 to 6/30/2008 ($450,000)
"Cooperative Agreement for Early Hearing Detection and Intervention, Tracking, Surveillance, and Intervention"

Rhode Island March of Dimes (PI), 1/1/2006 to 12/31/2006 ($9,305)
"Home Based Education and Support to Reduce Disparities in Outcomes of High Risk ELBW Infants"

PENDING GRANTS:

NIH (Co-PI), 7/1/2006 to 6/30/2011 ($89,255 plus capitation per patient)
"Gene Targets for IVH"

AUCD (PI), 9/1/2006 to 8/31/2009 ($256,275)
"Language and Behavioral Outcomes of Children with Congenital Hearing Loss"

PREVIOUS SUPPORT:

NINDS (Co-Investigator) 4/1/2005 to 3/31/2006 (Capitation per patient)
"Beneficial Effects of Antenatal Magnesium Sulfate (BEAM) Study"

NIH (Co-Investigator) 11/1/1999 to 10/31/2005
"Hyperglycemia and Adverse Pregnancy Outcome"

ATPM (Hawaii Department of Health) (PI) 10/1/2001 to 1/31/2004 ($47,210)
"Efficacy of OAE/ABR in Identifying Hearing Loss"

NICHD (Co-Investigator) 1999-2004
"Child Disability and the Family"

NIH Norton Consortium (PI), 1993-1998 ($433,366)
"Identification of Neonatal Hearing Impairment"

NIH (PI), 1977-1996 (PI) ($515,316)
"Infants of Gestational Diabetics Birth to 7 Years"

MCH (Co-Investigator) 1991-1994 ($794,251)
"Auditory Screen Trial for Neonates"

MCH (Co-Investigator) 1988-1993
"Behavioral Intervention with IUGR Infants"