NIH funding opportunities – Studies at Periviable Gestation

June 4, 2015 by School of Medicine Webmaster

This new FOA comes in R01, R03, and R21 versions (see bottom of this announcement).

One of the most complex areas in perinatal-neonatal medicine remains the care of the woman anticipating the delivery of an infant at the border of viability, including counseling her and her family. Equally difficult are the issues surrounding optimal care for such infants. For lack of appropriate phrase, such births are often referred to as “periviable” gestations. To address the issues related to knowledge gaps in this area of perinatal/neonatal medicine, to develop expert consensus, and to identify specific areas for research and education, NICHD organized a workshop in February of 2013. The workshop executive summary was published in an unprecedented manner, simultaneously, in three professional journals (J Perinatol. 2014 May;34(5):333-42; also in the May issues of AJOG and Obstetrics & Gynecology). This FOA stems from many of the recommendations made at the workshop, which the scientists across the spectrum of perinatal neonatal medicine felt to be extremely important and timely.

While managing and counseling women about to deliver at periviable gestations (20-25 weeks of GA), the healthcare team faces complex set of medical, emotional, and social challenges in an environment (clinical course) that may be rapidly changing. Even a few days of pregnancy prolongation can dramatically alter the potential for survival and long term outcome status, potentially altering treatment and counseling plans. To complicate matters, patient care practices have varied widely in this critical area of perinatal-neonatal medicine. Few randomized controlled trials have been carried out to identify optimal approaches to care of women and infants at periviable gestations, and to provide an evidence base for treatment.  The scope of this FOA includes the following areas:

Knowledge Gaps in Obstetrical Care Practices at Periviable Gestations

  • Development of evidence-based management approaches for medical and obstetrical complications before 26 weeks’ gestational age.
  • Identification of sensitive markers for periviable birth that will allow directed treatments before delivery is inevitable or required.
  • Determination of proximate causes of and antecedents to periviable birth.
  • Development of tools to assess and treat subclinical intrauterine infection and inflammation, and uteroplacental dysfunction.
  • Better understanding of survival and morbidity after periviable birth with respect to racial/ethnic and gender disparities.
  • Development of more accurate tools to assess gestational age, fetal growth, and reserve in the periviable period.
  • Identification of specific prenatal therapies and their effectiveness and efficacy to improve maternal neonatal outcomes should periviable birth be necessary: examples include, the use of antenatal steroid; antibiotics; tocolytic agents; fetal monitoring; mode of delivery; fetal neuroprotective agents such as MgS0­4.
  • Identification of antenatal markers for poor neonatal outcome subsequent to periviable birth that will allow individualized counseling and treatment of the patient at risk.
  • Determine the effects of classical Caesarian section performed for delivery at periviable gestation on long term reproductive health outcomes.

Knowledge Gaps in Neonatal Care at Periviable Gestations

  • Acute delivery room management of infants with attention to resuscitation, oxygen use, surfactant administration including team training programs.
  • Determination of optimal strategies of timing of umbilical cord clamping and cord milking in the periviable population.
  • Control of temperature and strategies for avoidance of hypothermia.
  • Development of strategies for lung and cardiovascular support to optimize short term and long-term outcome.
  • Establishment of evidence-based standards for fluid, electrolyte, nutrition, and environmental care for the ELBW infant.
  • Development of normal and abnormal postnatal growth rates after periviable birth, including head growth.
  • Skin management strategies to optimize barrier function and decrease infection.
  • Infection prevention and treatment modalities to improve short term and long-term outcome.
  • Brain injury and healing with specific attention to cytokines and their impact on injury, effects of drugs on the brain, effects of oxygen and varying oxygen saturations on the brain, development of neuroprotective mechanisms, attention to white matter injury.
  • Prevention and treatment of retinopathy of prematurity and hearing deficits.
  • Prevention and treatment of necrotizing enterocolitis.
  • Improving and optimizing long term outcome for ELBW infants including attention to chronic medical illnesses such as bronchopulmonary dysplasia, functional outcome, psychiatric, behavioral and attention issues, and the effects of interventions and their impact on outcome.

Research Needs Concerning Family Counseling

  • Studies to improve understanding of the family coping mechanisms, attitudes and perceptions regarding death and long term disabilities.
  • Development of educational materials for families at risk for and experiencing a periviable birth and testing the strengths and limitations of those materials. This could include assessment of drawings and cartoons.
  • Studies regarding optimal family-focused counseling methods (simulated experiments), including the appropriate usage of terms used during counseling (e.g., “disability” “morbidity” “handicap”); the effect of varying contents during counseling sessions on the decision making processes and family satisfaction.
  • How to train clinicians and other care takers in effective methods of counseling for patients and their families facing life-threatening clinical conditions. Studies to examine the impact of the extent and the nature of counseling on family understanding, perception, decision making, and satisfaction.
  • Improved understanding of the impact of language and terminology used on family understanding and decision making.
  • Improved understanding of the dynamics and impact of  paternal and family input on maternal decision making.
  • Studies directed at grief interventions for periviable gestations (20-25 weeks gestation).

– See more at:

Deadline:  standard deadlines apply


  • Studies at Periviable Gestation (R21)
    Eunice Kennedy Shriver National Institute of Child Health and Human Development
  • Studies at Periviable Gestation (R03)
    Eunice Kennedy Shriver National Institute of Child Health and Human Development
  • Studies at Periviable Gestation (R01)
    Eunice Kennedy Shriver National Institute of Child Health and Human Development

Filed Under: Funding Opportunities