Profile

Sandra E. Juul, MD, PhD

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."

Dr. Juul is principal investigator on studies focusing on the neuroprotective effects of erythropoietin (Epo) in neonatal models of brain injury. She has performed many preclinical trials to bring Epo neuroprotection from the bench to the bedside. Her research shows that Epo protects the neonatal brain from injury due to hypoxia and oxidative injury.

Dr. Juul's ultimate goal is to identify new therapeutic approaches to neonatal brain injury, determine whether they are safe and effective, first in preclinical models, and finally in patients at high risk for brain injury. Using a variety of approaches and several animal models, she is working to optimize Epo treatment in the developing brain at risk for injury. This work includes studies of pharmacokinetics, drug dosing, and duration of therapy as well as identifying mechanisms of Epo neuroprotection and possible synergistic treatments.

Dr. Juul is principal investigator on the PENUT Trial, a randomized, multi-center, placebo-controlled phase III trial designed to test the efficacy of erythropoietin (Epo) for the neuroprotection of extremely premature infants. Phase II trials of Epo and Darbepoetin neuroprotection in term infants with hypoxia-ischemia are also ongoing.

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 Name Award Description Awarded By Award Date
SEATTLE'S TOP DOCTOR - 2014 Seattle Metropolitan Magazine 2014

Publications

  • Traudt CM, McPherson RJ, Studholme C, Millen KJ, Juul SE
    Systemic glycerol decreases neonatal rabbit brain and cerebellar growth independent of intraventricular hemorrhage.
    Pediatric research , 2014 Mar. : 75(3)389-94
  • Traudt CM, McPherson RJ, Studholme C, Millen KJ, Juul SE
    Systemic glycerol decreases neonatal rabbit brain and cerebellar growth independent of intraventricular hemorrhage.
    Pediatric research , 2013 Dec. 17
  • Burbacher TM, Grant KS, Worlein J, Ha J, Curnow E, Juul S, Sackett GP
    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
  • Schober ME, Requena D, Block BP, Davis LJ, Rodesch C, Casper TC, Juul SE, Kesner RP, Lane RH
    Erythropoietin Improved Cognitive Function and Decreased Hippocampal Caspase Activity in Rat Pups after Traumatic Brain Injury.
    Journal of neurotrauma , 2013 Aug. 25
  • Hays SL, Valieva OA, McPherson RJ, Juul SE, Gleason CA
    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
  • Juul SE
    Hypothermia plus erythropoietin for neonatal neuroprotection? Commentary on Fan et al. and Fang et al.
    Pediatric research , 2013 Jan. : 73(1)10-1
  • Traudt CM, Juul SE
    Erythropoietin as a neuroprotectant for neonatal brain injury: animal models.
    Methods in molecular biology (Clifton, N.J.) , 2013 : 982113-26
  • Traudt CM, McPherson RJ, Bauer LA, Richards TL, Burbacher TM, McAdams RM, Juul SE
    Concurrent erythropoietin and hypothermia treatment improve outcomes in a term nonhuman primate model of perinatal asphyxia.
    Developmental neuroscience , 2013 : 35(6)491-503
  • Traudt CM, Juul SE
    Erythropoietin as a neuroprotectant for neonatal brain injury: animal models.
    Methods in molecular biology (Clifton, N.J.) , 2013 : 982113-26
  • Traudt CM, McPherson RJ, Bauer LA, Richards TL, Burbacher TM, McAdams RM, Juul SE
    Concurrent erythropoietin and hypothermia treatment improve outcomes in a term nonhuman primate model of perinatal asphyxia.
    Developmental neuroscience , 2013 : 35491-503
  • Juul SE
    Hypothermia plus erythropoietin for neonatal neuroprotection? Commentary on Fan et al. and Fang et al.
    Pediatric research , 2013 Jan. : 73(1)10-1
  • Traudt CM, Juul SE
    Erythropoietin as a neuroprotectant for neonatal brain injury: animal models.
    Methods in molecular biology (Clifton, N.J.) , 2013 : 982113-26
  • Wu YW, Bauer LA, Ballard RA, Ferriero DM, Glidden DV, Mayock DE, Chang T, Durand DJ, Song D, Bonifacio SL, Gonzalez FF, Glass HC, Juul SE
    Erythropoietin for neuroprotection in neonatal encephalopathy: safety and pharmacokinetics.
    Pediatrics , 2012 Oct. : 130(4)683-91
  • Juul S
    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
  • Juul S
    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 , 2012 Oct. : 25(Suppl 5)80-4
  • Juul S
    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
  • Wu YW, Bauer LA, Ballard RA, Ferriero DM, Glidden DV, Mayock DE, Chang T, Durand DJ, Song D, Bonifacio SL, Gonzalez FF, Glass HC, Juul SE
    Erythropoietin for neuroprotection in neonatal encephalopathy: safety and pharmacokinetics.
    Pediatrics , 2012 Oct. : 130(4)683-91
  • Juul S
    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
  • Juul S
    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
  • Cheng CF, Zerzan JC, Johnson DB, Juul SE
    Zinc protoporphyrin-to-heme ratios in high-risk and preterm infants.
    The Journal of Pediatrics , 2012 July : 161(1)81-7.e1
  • Bennet L, Tan S, Van den Heuij L, Derrick M, Groenendaal F, van Bel F, Juul S, Back SA, Northington F, Robertson NJ, Mallard C, Gunn AJ
    Cell therapy for neonatal hypoxia-ischemia and cerebral palsy.
    Annals of neurology , 2012 May : 71(5)589-600
  • Beckstrom AC, Tanya P, Humston EM, Snyder LR, Synovec RE, Juul SE
    The perinatal transition of the circulating metabolome in a nonhuman primate.
    Pediatric research , 2012 Apr, : 71(4 Pt 1)338-44
  • Robertson NJ, Tan S, Groenendaal F, van Bel F, Juul SE, Bennet L, Derrick M, Back SA, Valdez RC, Northington F, Gunn AJ, Mallard C
    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
  • Robertson NJ, Tan S, Groenendaal F, van Bel F, Juul SE, Bennet L, Derrick M, Back SA, Valdez RC, Northington F, Gunn AJ, Mallard C
    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
  • Hays SL, McPherson RJ, Juul SE, Wallace G, Schindler AG, Chavkin C, Gleason CA
    Long-term effects of neonatal stress on adult conditioned place preference (CPP) and hippocampal neurogenesis.
    Behavioural brain research , 2012 Feb. : 227(1)7-11
  • McAdams RM, Juul SE
    The role of cytokines and inflammatory cells in perinatal brain injury.
    Neurology research international , 2012 : 2012561494

Presentations

Presentations Title Event Location Date
DANCE (Darbe Administration In Newborns Undergoing Cooling For Encephalopathy): Safety And Pharmacokinetic Trial WSPR 2014 Platform presentation 2014
Can we improve the outcome of prematurity? Grand Rounds at the University of New Mexico Department of Pediatrics Nov. 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 Minneapolis Minneapolis, Minnesota Sept. 24, 2013
Can we improve the outcome of prematurity? Newborn Medicine Grand Rounds for the Harvard Program in Neonatology Boston Childrens Hospital Sept. 9, 2013
Can we improve the outcome of prematurity? UT Southwestern Pediatric Grand Rounds April 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 Asphyxia PAS 2013 Platform presentation 2013
DANCE (Darbe Administration In Newborn Undergoing Cooling for Encephalopathy):Safety And Pharmacokinetic Trial. WSPR 2014 Platform Presentation 2013
Metabolomic profiles after perinatal asphyxia (PA) and correlations with neurodevelopment outcomes in a nonhuman primate model. PAS Poster 2013 2013
Erythropoietin (EPO) With Hypothermia (Ht) Provides Improved Neuroprotection In A Nonhuman Primate Model Of Perinatal Asphyxia PAS 2013 Platform Presentation 2013
Neuroprotective role of Epo National Congress of Italian Society of Neonatology (SIN) Rome, Italy Oct. 3, 2012 - Oct. 6, 2012
Erythropoiesis and the approach to anemia of prematurity; The ultimate word on the use of Erythropoietin in anemia of prematurity Seminars in Neonatal Hematology Bari, Italy Oct. 1, 2012 - Oct. 2, 2012
Biomarkers of neonatal encephalopathy in a nonhuman primate model 2012 Northwest Metabolomics Research Center Metabolomics Symposium Sept. 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? Ipokrates Lecco, Italy May 24, 2012 - May 26, 2012
Erythropoietin: Is this the next cool neuroprotectant? MidAtlantic Neonatology meeting March 2012
Erythropoietin: Is this the next cool neuroprotectant? California Association of Neonatologists (CAN) March 2012
Phase I Trial Of Neonatal Erythropoietin In Perinatal Hypoxic-Ischemic Encephalopathy PAS 2012 Platform presentation 2012
Therapeutic Hypothermia Plus Erythropoietin Alters Early MRI Findings after Perinatal Asphyxia in a Macaque Model PAS Platform Presentation 2012 2012
Use of diffusion tensor images as biomarkers of neonatal encephalopathy using a macaque model 33rd Western Conference on Perinatal Research Indian Wells CA 2012
A Case Study of Cerebral Palsy (CP) after Neonatal Encephalopathy (NE) in a Macaque Model PAS Poster 2012 2012
Phase I Trial Of Neonatal Erythropoietin In Perinatal Hypoxic-Ischemic Encephalopathy WSPR 2012 Platform presentation. 2012

Research Funding

Grant Title Grantor Amount Award Date
Biomarkers of brain injury and inflammation in perinatal hypoxic ischaemic encephalopathy. Innovative Research Grant, CP Alliance. $120,000 Jan. 2, 2014 - Jan. 1, 2015
Neonatal Erythropoietin and Therapeutic Hypothermia Outcomes Study (NEAT O). Thrasher Foundation Sept. 1, 2013 - Aug. 30, 2015
Biomarkers of neonatal encephalopathy in a nonhuman primate model. NICHD 1 R01 HD073128-01A1 $2,496,627 July 1, 2013 - June 30, 2018
Preterm Erythropoietin Neuroprotection Trial (PENUT Trial) CCC. NINDS 1U01NS077953-01 $10,255,370 July 1, 2013 - June 30, 2018
DANCE trial. Darbepoietin Administration in Newborns Undergoing Cooling for Encephalopathy Thrasher 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
ARRA supplement to R01-HD-52820-01A3 NICHD $204100 2009 - 2012