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Sandra E. Juul, MD, PhD

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Sandra E. Juul, MD, PhD

Neonatology

On staff since July 2000

Children's Title: Director, Neonatology Fellowship; Associate Division Chief, Research and Scholarship

Academic Title: Professor of Pediatrics

Research Center: Center for Integrative Brain Research

"As a neonatologist, I am privileged to participate in the care of the most precious, fragile individuals. These small patients and their families often humble me with their insights and endurance in the face of great adversity. I believe that my role as an academic neonatologist is to bring the field forward by focusing on specific clinical problems and, through research efforts, to try to solve or shed light on them. My research focuses on neonatal neuroprotection: how to protect the brain from injury, and how to repair the injured brain."

Overview

Board Certification(s)
Pediatrics
Neonatal-Perinatal Medicine
Medical/Professional School
University of Washington School of Medicine, Seattle
University of Chicago, Chicago
Residency
Pediatrics, University of Washington School of Medicine, Seattle
Fellowship
Neonatal-Perinatal Medicine, Seattle Children's Hospital, Seattle
Clinical Interests

Non-hematopoietic effects of erythropoietin (Epo), particularly its neuroprotective effects. Hematopoiesis and iron balance in preterm infants are additional areas of interest and research.

Research Description

Recombinant erythropoietin (rEpo) has been used since 1989 as an erythropoietic agent in adults and children. More recently, Epo effects have been recognized in tissues other than bone marrow. Functional receptors for Epo are present in the developing brain, liver, heart, blood vessels, and intestine.

During development, endogenous Epo acts as a general trophic and anti-apoptotic factor. Mechanisms of Epo action are being investigated. Two promising areas of research include the use of rEpo to prevent or ameliorate necrotizing enterocolitis, and the use of rEpo to decrease brain damage following injury such as perinatal hypoxia-ischemia.

Using a variety of molecular biology, cell and tissue culture techniques, and in vivo models, Dr. Juul's research is focused on determining the effects of Epo on neurodevelopment, neuroprotection, intestinal development, and intestinal injury. Additional areas of interest include neonatal hematology, and iron deficiency in the developing neonate.

Research Focus Area

Neuroscience / Neurodevelopment

Awards and Honors

Award NameAward DescriptionAwarded ByAward Date
SEATTLE'S TOP DOCTOR - 2014Seattle Metropolitan Magazine 2014

Publications

Systemic glycerol decreases neonatal rabbit brain and cerebellar growth independent of intraventricular hemorrhage.
Pediatric research , 2014 Mar: 75(3)389-94
Systemic glycerol decreases neonatal rabbit brain and cerebellar growth independent of intraventricular hemorrhage.
Pediatric research , 2013 Dec 17
Four decades of leading-edge research in the reproductive and developmental sciences: the Infant Primate Research Laboratory at the University of Washington National Primate Research Center.
American journal of primatology , 2013 Nov: 75(11)1063-83
Erythropoietin Improved Cognitive Function and Decreased Hippocampal Caspase Activity in Rat Pups after Traumatic Brain Injury.
Journal of neurotrauma , 2013 Aug 25
Adult responses to an ischemic stroke in a rat model of neonatal stress and morphine treatment.
International journal of developmental neuroscience : the official journal of the International Society for Developmental Neuroscience , 2013 Feb: 31(1)25-9
Hypothermia plus erythropoietin for neonatal neuroprotection? Commentary on Fan et al. and Fang et al.
Pediatric research , Jan. 2013: 73(1)10-1
Erythropoietin as a neuroprotectant for neonatal brain injury: animal models.
Methods in molecular biology (Clifton, N.J.) , 2013: 982113-26
Concurrent erythropoietin and hypothermia treatment improve outcomes in a term nonhuman primate model of perinatal asphyxia.
Developmental neuroscience , 2013: 35491-503
Erythropoietin as a neuroprotectant for neonatal brain injury: animal models.
Methods in molecular biology (Clifton, N.J.) , 2013: 982113-26
Concurrent erythropoietin and hypothermia treatment improve outcomes in a term nonhuman primate model of perinatal asphyxia.
Developmental neuroscience , 2013: 35(6)491-503
Erythropoietin as a neuroprotectant for neonatal brain injury: animal models.
Methods in molecular biology (Clifton, N.J.) , 2013: 982113-26
Hypothermia plus erythropoietin for neonatal neuroprotection? Commentary on Fan et al. and Fang et al.
Pediatric research , 2013 Jan: 73(1)10-1
Erythropoiesis and the approach to anemia in premature infants.
The journal of maternal-fetal & neonatal medicine : the official journal of the European Association of Perinatal Medicine, the Federation of Asia and Oceania Perinatal Societies, the International Society of Perinatal Obstetricians , Oct. 2012: 25(Suppl 5)97-9
Erythropoietin in anemia of prematurity.
The journal of maternal-fetal & neonatal medicine : the official journal of the European Association of Perinatal Medicine, the Federation of Asia and Oceania Perinatal Societies, the International Society of Perinatal Obstetricians , Oct. 2012: 25(Suppl 5)80-4
Neuroprotective role of erythropoietin in neonates.
The journal of maternal-fetal & neonatal medicine : the official journal of the European Association of Perinatal Medicine, the Federation of Asia and Oceania Perinatal Societies, the International Society of Perinatal Obstetricians , Oct. 2012: 25 Suppl 4105-7
Erythropoietin for neuroprotection in neonatal encephalopathy: safety and pharmacokinetics.
Pediatrics , Oct. 2012: 130(4)683-91
Erythropoiesis and the approach to anemia in premature infants.
The journal of maternal-fetal & neonatal medicine : the official journal of the European Association of Perinatal Medicine, the Federation of Asia and Oceania Perinatal Societies, the International Society of Perinatal Obstetricians , 2012 Oct: 25(Suppl 5)97-9
Neuroprotective role of erythropoietin in neonates.
The journal of maternal-fetal & neonatal medicine : the official journal of the European Association of Perinatal Medicine, the Federation of Asia and Oceania Perinatal Societies, the International Society of Perinatal Obstetricians , 2012 Oct: 25 Suppl 4105-7
Erythropoietin for neuroprotection in neonatal encephalopathy: safety and pharmacokinetics.
Pediatrics , 2012 Oct: 130(4)683-91
Zinc protoporphyrin-to-heme ratios in high-risk and preterm infants.
The Journal of Pediatrics , July 2012: 161(1)81-7.e1
Cell therapy for neonatal hypoxia-ischemia and cerebral palsy.
Annals of neurology , May 2012: 71(5)589-600
Which neuroprotective agents are ready for bench to bedside translation in the newborn infant?
The Journal of pediatrics , April 2012: 160(4)544-552.e4
The perinatal transition of the circulating metabolome in a nonhuman primate.
Pediatric research , April 2012: 71(4 Pt 1)338-44
Which neuroprotective agents are ready for bench to bedside translation in the newborn infant?
The Journal of pediatrics , 2012 Apr: 160(4)544-552.e4
Long-term effects of neonatal stress on adult conditioned place preference (CPP) and hippocampal neurogenesis.
Behavioural brain research , Feb. 2012: 227(1)7-11
The role of cytokines and inflammatory cells in perinatal brain injury.
Neurology research international , 2012: 2012561494
Hypothermia and other treatment options for neonatal encephalopathy: an executive summary of the Eunice Kennedy Shriver NICHD workshop.
The Journal of pediatrics , Nov. 2011: 159(5)851-858.e1
Hypothermia and other treatment options for neonatal encephalopathy: an executive summary of the Eunice Kennedy Shriver NICHD workshop.
The Journal of pediatrics , 2011 Nov: 159(5)851-858.e1
Time course of C-reactive protein and inflammatory mediators after neonatal surgery.
The Journal of pediatrics , July 2011: 159(1)121-6
Application of comprehensive two-dimensional gas chromatography with time-of-flight mass spectrometry method to identify potential biomarkers of perinatal asphyxia in a non-human primate model.
Journal of chromatography. A , April 2011: 1218(14)1899-906
Effects of neonatal stress and morphine on murine hippocampal gene expression.
Pediatric research , April 2011: 69(4)285-92
Application of comprehensive two-dimensional gas chromatography with time-of-flight mass spectrometry method to identify potential biomarkers of perinatal asphyxia in a non-human primate model.
Journal of chromatography. A , 2011 Apr 8: 1218(14)1899-906
Effects of neonatal stress and morphine on murine hippocampal gene expression.
Pediatric research , 2011 Apr: 69(4)285-92
Perinatal asphyxia in a nonhuman primate model.
Developmental neuroscience , 2011: 33(3-4)210-21
Perinatal asphyxia in a nonhuman primate model.
Developmental neuroscience , 2011: 33(3-4)210-21
Left ventricular hypertrophy is prevalent in Sprague-Dawley rats.
Comparative medicine , Oct. 2010: 60(5)357-63
Erythropoietin: not just about erythropoiesis.
Lancet , June 2010: 375(9732)2142
Erythropoietin for infants with hypoxic-ischemic encephalopathy.
Current opinion in pediatrics , April 2010: 22(2)139-45
High-dose erythropoietin does not exacerbate retinopathy of prematurity in rats.
Pediatric research , Dec. 2009: 66(6)625-30
High-dose erythropoietin does not exacerbate retinopathy of prematurity in rats.
Pediatric research , 2009 Dec: 66(6)625-30
Effects of transfusions in extremely low birth weight infants: a retrospective study.
The Journal of pediatrics , Sept. 2009: 155(3)331-37.e1
Postnatal stress produces hyperglycemia in adult rats exposed to hypoxia-ischemia.
Pediatric research , Sept. 2009: 66(3)278-82
Effects of transfusions in extremely low birth weight infants: a retrospective study.
The Journal of pediatrics , 2009 Sep: 155(3)331-37.e1
Resident duty hour restrictions: is less really more?
The Journal of pediatrics , May 2009: 154(5)631-632.e1
Microarray analysis of high-dose recombinant erythropoietin treatment of unilateral brain injury in neonatal mouse hippocampus.
Pediatric research , May 2009: 65(5)485-92
Resident duty hour restrictions: is less really more?
The Journal of pediatrics , 2009 May: 154(5)631-632.e1
Effects of neonatal stress and morphine on kappa opioid receptor signaling.
Neonatology , 2009: 96(4)235-43
Neonatal stress or morphine treatment alters adult mouse conditioned place preference.
Neonatology , 2009: 95(3)230-9
Neonatal stress or morphine treatment alters adult mouse conditioned place preference.
Neonatology , 2009: 95(3)230-9
A phase I/II trial of high-dose erythropoietin in extremely low birth weight infants: pharmacokinetics and safety.
Pediatrics , Aug. 2008: 122(2)383-91
Recent trends in erythropoietin-mediated neuroprotection.
International journal of developmental neuroscience : the official journal of the International Society for Developmental Neuroscience , Feb. 2008: 26(1)103-11
Recent trends in erythropoietin-mediated neuroprotection.
International journal of developmental neuroscience : the official journal of the International Society for Developmental Neuroscience , 2008 Feb: 26(1)103-11
Recombinant erythropoietin is neuroprotective in a novel mouse oxidative injury model.
Developmental neuroscience , 2008: 30(4)231-42
Characterization of developing bowel transplanted from transgenic erythropoietin receptor-deficient mouse embryos.
Neonatology , 2008: 93(1)56-63
Recombinant erythropoietin is neuroprotective in a novel mouse oxidative injury model.
Developmental neuroscience , 2008: 30(4)231-42
Characterization of developing bowel transplanted from transgenic erythropoietin receptor-deficient mouse embryos.
Neonatology , 2008: 93(1)56-63
High-dose erythropoietin inhibits apoptosis and stimulates proliferation in neonatal rat intestine.
Growth hormone & IGF research : official journal of the Growth Hormone Research Society and the International IGF Research Society , Oct. 2007: 17(5)424-30
Epo and other hematopoietic factors.
Seminars in fetal & neonatal medicine , Aug. 2007: 12(4)250-8
Pharmacokinetics of high-dose recombinant erythropoietin in plasma and brain of neonatal rats.
Pediatric research , June 2007: 61(6)671-5
A comparison of high-dose recombinant erythropoietin treatment regimens in brain-injured neonatal rats.
Pediatric research , April 2007: 61(4)451-5
A comparison of high-dose recombinant erythropoietin treatment regimens in brain-injured neonatal rats.
Pediatric research , 2007 Apr: 61(4)451-5
Prenatal cord clamping in newborn Macaca nemestrina: a model of perinatal asphyxia.
Developmental neuroscience , 2007: 29(4-5)311-20
A new model of neonatal stress which produces lasting neurobehavioral effects in adult rats.
Neonatology , 2007: 92(1)33-41
Safety of high-dose recombinant erythropoietin in a neonatal rat model.
Neonatology , 2007: 91(1)36-43
Prenatal cord clamping in newborn Macaca nemestrina: a model of perinatal asphyxia.
Developmental neuroscience , 2007: 29(4-5)311-20
A new model of neonatal stress which produces lasting neurobehavioral effects in adult rats.
Neonatology , 2007: 92(1)33-41
Safety of high-dose recombinant erythropoietin in a neonatal rat model.
Neonatology , 2007: 91(1)36-43
Iron sulfate supplementation decreases zinc protoporphyrin to heme ratio in premature infants.
The Journal of pediatrics , Jan. 2006: 148(1)44-8
Erythropoietin protects dopaminergic neurons and improves neurobehavioral outcomes in juvenile rats after neonatal hypoxia-ischemia.
Pediatric research , Aug. 2005: 58(2)297-301
Evaluation of eosinophilia in hospitalized preterm infants.
Journal of perinatology : official journal of the California Perinatal Association , March 2005: 25(3)182-8
Patterns of thrombocytosis and thrombocytopenia in hospitalized neonates.
Journal of perinatology : official journal of the California Perinatal Association , March 2005: 25(3)166-72
Patterns of thrombocytosis and thrombocytopenia in hospitalized neonates.
Journal of perinatology : official journal of the California Perinatal Association , 2005 Mar: 25(3)166-72
Recombinant erythropoietin as a neuroprotective treatment: in vitro and in vivo models.
Clinics in perinatology , March 2004: 31(1)129-42
Evaluation of neutropenia and neutrophilia in hospitalized preterm infants.
Journal of perinatology : official journal of the California Perinatal Association , March 2004: 24(3)150-7
Recombinant erythropoietin as a neuroprotective treatment: in vitro and in vivo models.
Clinics in perinatology , 2004 Mar: 31(1)129-42
Evaluation of neutropenia and neutrophilia in hospitalized preterm infants.
Journal of perinatology : official journal of the California Perinatal Association , 2004 Mar: 24(3)150-7
Erytropoietin concentrations in cerebrospinal fluid of nonhuman primates and fetal sheep following high-dose recombinant erythropoietin.
Biology of the neonate , 2004: 85(2)138-44
Enterally dosed recombinant human erythropoietin does not stimulate erythropoiesis in neonates.
The Journal of pediatrics , Sept. 2003: 143(3)321-6
Effect of recombinant granulocyte colony-stimulating factor on blood neutrophil concentrations among patients with "idiopathic neonatal neutropenia": a randomized, placebo-controlled trial.
Journal of perinatology : official journal of the California Perinatal Association , Sept. 2003: 23(6)493-7
Effect of recombinant granulocyte colony-stimulating factor on blood neutrophil concentrations among patients with "idiopathic neonatal neutropenia": a randomized, placebo-controlled trial.
Journal of perinatology : official journal of the California Perinatal Association , 2003 Sep: 23(6)493-7
Absorption of enteral recombinant human erythropoietin by neonates.
The Annals of pharmacotherapy , June 2003: 37(6)782-6
Zinc protoporphyrin/heme as an indicator of iron status in NICU patients.
The Journal of pediatrics , March 2003: 142(3)273-8
Erythropoietin in human milk: physiology and role in infant health.
Journal of human lactation : official journal of International Lactation Consultant Association , Aug. 2002: 18(3)252-61
The effect of interleukin-1beta (IL-1beta) and tumor necrosis factor-alpha (TNF-alpha) on granulocyte macrophage-colony stimulating factor (GM-CSF) production by neuronal precursor cells.
European cytokine network , Jan. 2002: 13(1)128-33
The effect of interleukin-1beta (IL-1beta) and tumor necrosis factor-alpha (TNF-alpha) on granulocyte macrophage-colony stimulating factor (GM-CSF) production by neuronal precursor cells.
European cytokine network , 2002 Jan-Mar: 13(1)128-33

Presentations

Presentations TitleEventLocationDate
DANCE (Darbe Administration In Newborns Undergoing Cooling For Encephalopathy): Safety And Pharmacokinetic TrialWSPR 2014 Platform presentation 2014
Can we improve the outcome of prematurity?Grand Rounds at the University of New Mexico Department of PediatricsNov. 14, 2013
Can we improve the outcome of prematurity?Grant Rounds at Amplatz Childrens Hospital Sept. 25, 2013
History of Neonatology - Whats new in HIE?Childrens Hospital of MinneapolisMinneapolis, MinnesotaSept. 24, 2013
Can we improve the outcome of prematurity?Newborn Medicine Grand Rounds for the Harvard Program in NeonatologyBoston Childrens HospitalSept. 9, 2013
Can we improve the outcome of prematurity?UT Southwestern Pediatric Grand RoundsApril 17, 2013
Brain injury in the preterm infant: can we improve outcomes?Australian Neuroscience Society (ANS)Feb. 6, 2013
Erythropoietin (EPO) With Hypothermia (Ht) Provides Improved Neuroprotection In A Nonhuman Primate Model Of Perinatal AsphyxiaPAS 2013 Platform Presentation 2013
Metabolomic profiles after perinatal asphyxia (PA) and correlations with neurodevelopment outcomes in a nonhuman primate model.PAS Poster 2013 2013
DANCE (Darbe Administration In Newborn Undergoing Cooling for Encephalopathy):Safety And Pharmacokinetic Trial.WSPR 2014 Platform Presentation 2013
Erythropoietin (Epo) With Hypothermia (Ht) Provides Improved Neuroprotection In A Nonhuman Primate Model Of Perinatal AsphyxiaPAS 2013 Platform presentation 2013
Neuroprotective role of EpoNational Congress of Italian Society of Neonatology (SIN) Rome, ItalyOct. 3, 2012 - Oct. 6, 2012
Erythropoiesis and the approach to anemia of prematurity; The ultimate word on the use of Erythropoietin in anemia of prematuritySeminars in Neonatal HematologyBari, ItalyOct. 1, 2012 - Oct. 2, 2012
Biomarkers of neonatal encephalopathy in a nonhuman primate model2012 Northwest Metabolomics Research Center Metabolomics SymposiumSept. 14, 2012
a.Neonatal Iron Balance: What does it matter? b.Transfusions in the NICU: Is more better? c. Epo Neuroprotection: Is this the next cool thing? d.Neonatal Sedation: What is on the horizon?IpokratesLecco, ItalyMay 24, 2012 - May 26, 2012
Erythropoietin: Is this the next cool neuroprotectant?California Association of Neonatologists (CAN)March 2012
Erythropoietin: Is this the next cool neuroprotectant?MidAtlantic Neonatology meetingMarch 2012
Phase I Trial Of Neonatal Erythropoietin In Perinatal Hypoxic-Ischemic EncephalopathyWSPR 2012 Platform presentation. 2012
A Case Study of Cerebral Palsy (CP) after Neonatal Encephalopathy (NE) in a Macaque ModelPAS Poster 2012 2012
Use of diffusion tensor images as biomarkers of neonatal encephalopathy using a macaque model33rd Western Conference on Perinatal ResearchIndian Wells CA 2012
Therapeutic Hypothermia Plus Erythropoietin Alters Early MRI Findings after Perinatal Asphyxia in a Macaque ModelPAS Platform Presentation 2012 2012
Phase I Trial Of Neonatal Erythropoietin In Perinatal Hypoxic-Ischemic EncephalopathyPAS 2012 Platform presentation 2012
Update on EPO Neuroprotection, Has its Time Come?Washington, D.C.Dec. 2011
Neonatal Controversies - Neonatal Imaging. For whom, what studies, when?SeattleNov. 2011
New Concepts in Neonatal Intensive Care - Is there a Role for Erythropoietin as a Neuroprotective Strategy in At Risk Preterm and Term Newborn Infants?CornellOct. 2011
Therapeutic Hypothermia for Neonatal Encephalopathy (NE)Neonatal Grand RoundsSeattleOct. 2011
The combination of hypothermia plus erythropoietin (Epo) alters cerebrospinal fluid (CSF) proteins in non-human primates exposed to perinatal asphyxia (PA)PAS 2011 Platform presentation 2011
Neonatal stress - induced disruption of conditioned place preference (CPP) is reversed by the Kappa Opioid Receptor Agonist U50,488PAS 2011 Poster presentation 2011
The metabolic profile of birth in a nonhuman primate modelDistrict VIII 2011
Erythropoietin decreases hippocampal apoptosis and improves cognitive outcome in a rat model of pediatric TBINeurotrauma Symposium 2011 2011
12. "Treating Neonatal Brain Injury: Novel concepts" Western conference on perinatal research. Palm Springs 2011
13. Invited Speaker: 8th Annual Dialogues in Neonatal-Perinatal MedicineDuke 2011
14. "Nonhuman Primate Model of Perinatal Asphyxia" Newborn Neurological Disorders Leading to Cerebral PalsyCalifornia Institute of Regenerative Medicine 2011

Research Funding

Grant TitleGrantorAmountAward Date
Biomarkers of brain injury and inflammation in perinatal hypoxic ischaemic encephalopathy.Innovative Research Grant, CP Alliance. $120,000Jan. 2, 2014 - Jan. 1, 2015
Neonatal Erythropoietin and Therapeutic Hypothermia Outcomes Study (NEAT O).Thrasher FoundationSept. 1, 2013 - Aug. 30, 2015
Preterm Erythropoietin Neuroprotection Trial (PENUT Trial) CCC.NINDS 1U01NS077953-01 $10,255,370July 1, 2013 - June 30, 2018
Biomarkers of neonatal encephalopathy in a nonhuman primate model.NICHD 1 R01 HD073128-01A1 $2,496,627July 1, 2013 - June 30, 2018
DANCE trial. Darbepoietin Administration in Newborns Undergoing Cooling for EncephalopathyThrasher Grant $45,252 2012 - 2014
A Novel Non-Human Primate Model of Neonatal Stress and Sedative Drug Use.Institute of Translational Health Sciences $67500 2010 - 2012
Epo Neuroprotection of ELBW Infants: Planning GrantNINDS R34NS061593 $100000 2010 - 2011
NEAT study: Neonatal Erythropoietin in Asphyxiated Term NewbornsThrasher Grant $231,000 2010 - 2011
ARRA supplement to R01-HD-52820-01A3NICHD $204100 2009 - 2012

Primary Office

University of Washington
UW Box 356320 - Neonatology
1959 NE Pacific St
Seattle, WA 98195-6320
206-543-3200

Additional Offices

Seattle Children's
M1-12 - NICU Administration
4800 Sand Point Way NE
Seattle, WA 98105
206-987-2041

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