Steering Committee Interview: Dr. Terrie Inder


The Steering Committee, consisting of the founding members of the Newborn Brain Society, plays an integral role advising the society and helping to maintain our mission, vision, and objectives. One of the seven members of the Steering Committee is Dr. Terrie Inder, the first appointed chair of the Department of Pediatric Newborn Medicine at Brigham and Women’s Hospital in Boston, Massachusetts.

 

Dr. Inder, a native New Zealander, received her education and training at the University of Otago in Dunedin. It was there that she completed her residency in Pediatrics and fellowship in Newborn Medicine. Dr. Inder describes why she transitioned from pediatrics to neonatology, citing the impact the babies in the NICU had on her. She says, “It was so disheartening to see that there weren’t many ways to help them. This motivated me to learn more, so I sought out the leader of the field at the time – Dr. Volpe – and spent 3 years learning from him in Boston.” It was at Boston Children’s Hospital that she completed another fellowship in Pediatric Neurology. Her first faculty appointment was at the University of Melbourne, Royal Children’s Hospital in 2001, and five years later she moved to St Louis Children’s Hospital at Washington University in St Louis as an Associate Professor.

 

Dr. Inder’s major discoveries have been in “clinical and translation research into the nature and timing of brain injury in preterm and high-risk term born infants.” She has also done quite a bit of research on the effects of drugs on the newborn brain and has followed babies into adolescence to assess the outcomes. When asked whether the effects of drugs on the newborn brain are being adequately discussed, she answered, “no, [the topic is] not being discussed enough. It has even bigger implications. 80% of all pregnant women are on at least one prescription drug and 20% are on five or more. This is highly relevant to all babies. New studies need to more fully explore the effects of drugs, like marijuana and anti-depressants, on brain development in newborns.”

 

Recently, Dr. Inder has also contributed to research about the effects of the environment on neonatal brain development. She comments that “the current NICU environment could be improved substantially. The parents should be empowered and engaged to make decisions and care for their baby. Then the whole family becomes the center – not just the baby– which promotes nurturing.” She has recently published a paper on this topic focused on understanding the room environment and how it affects newborns. She describes it here, saying, “In that publication I referenced a Dave Mathew song saying, ‘it’s not where you are, but who you’re with,’ referring to the fact that a room environment is most influential when it affects how long parents are present with their babies. It has been shown that single family rooms lead to less infections through shared parent decision making. In the US, parents typically only spend around 2-4 hours with their NICU babies, as opposed to Europe’s average of 17 hours, which has been shown to have a direct effect on the babies.”

 

With an impressive 245 total publications, Dr. Inder cites a few as some of her favorites over the years. Her first publication was actually about car seat safety for babies, and she notes that she worked alongside an influential figure to write it. She also mentions “the one that has the most citations is probably the one published in the New England Journal. It [discusses] using MRI of the newborn brain to help predict outcome in the preterm infant. Another one is the mechanistic work that I did with Dr. Volpe. This one [discusses] white and gray matter injury in preterm newborns and was actually the first [publication] to show gray matter injuries in newborns.”

 

Because of her many contributions to the field, Dr. Inder has received several awards over the years, such as the Women’s Federation Prize, the Child Neurology Society Young Investigator Award, and the Hugs for Hero’s Award. When asked if there are any that hold a special place, she said, “There [are] probably two: the Doris Duke Award, because I love mentoring, and also being a finalist for the Schwartz center because it was an honor to be recognized as a compassionate caregiver.” Mentoring young faculty is one of Dr. Inder’s greatest passions. She says, “It is a privilege to mentor and watch young physicians start to grow their own passions in the field.” Dr. Inder currently mentors six K-level career trainees and several PhD students, in addition to the courses she teaches and fellows she supervises. She has even created a specialized fetal and neonatal neurological consultation service, which is essentially a training pipeline for neurologists and newborn medicine specialists. She has been very clear about her “commitment to mentoring the next generation of clinical investigators [in the field].”

 

Throughout Dr. Inder’s experience, she says she has learned that “the most important thing is to provide a toolkit for the trainee in two ways: the intellectual content, as in knowledge of the field, and the common research tools, like how to write a good hypothesis, aims, etc. which are universal.” She says that these, coupled with passion will result in great success. She also comments that “the newborn brain is hard. Many students in school shy away from neurology because it is hard, and the newborn brain is even more complicated. Any way to simplify or amplify the message will help babies. If we can train and help people to understand the newborn brain, and then they can go and train their people, we can help more babies.” She offers some advice to trainees and others that are new to the field, saying “find your passion and find really good people that you trust and will support your growth. Have pride in your accomplishments. We oftentimes are so focused on looking ahead that we forget to celebrate how far we’ve come.”

 

As an expert in the field of newborn brain care, Dr. Inder shares her views on the field so far. She says that one of the most important things the field has accomplished is, “definitely therapeutic hypothermia for term infants, as well as seizure monitoring and trials. The next challenge is tackling the preterm infant as there are no substantial therapies for them.” She expects that the field “will go to diagnostics to better understand cerebral blood flow as well as better immediate neuroprotection and regenerative medicine like stem cells.” She also discusses the social aspect of the field. “In neonatology, females now have predominance, and in newborn brain care, but this brings its own challenges. I was the first female chair here at Brigham. There are not as many females in leadership positions. It’s not just hiring and retaining women, but promoting them as well.” As a former member of the Washington University in St. Louis Gender Equity Committee and the Brigham & Women’s Office of Women’s Affairs, as well as currently being the first female chair at Brigham and Women’s Hospital, Dr. Inder has been an advocate for gender equity in the field for quite some time.

 

As one of the founding members of the Newborn Brain Society, who has followed up with the society since its early beginnings, Dr. Inder discusses her hopes for the future of the organization. “I’m incredibly proud of the NBS. It went from a small after-conference dinner table discussion to a large international organization.” She hopes it will broaden its impact “through guidelines and lectures that show the importance of newborn brain care.” When asked about possible challenges regarding the society, she says, “It requires passion and a very certain type of person because it is not necessarily rewarded in the traditional accolades. Also, the immense amount of time it takes to organize something like this is not revered in the way writing three or four manuscripts is. That’s why it requires a special kind of people who are committed to serving babies (and their colleagues).”

 

Over the years Dr. Inder has contributed to the field in so many ways, and we are very fortunate to have her as an integral part of the society. When asked if she would go back and do anything differently she answered, “I would slow down and spend more time enjoying the journey.” She also offered a glimpse into her life, saying “What I’m most proud of is my three beautiful children. Things I learned along the way are that it is often more important to listen than to talk, and more important to pause and consider than to rush on. You also need to understand and accept that things are the way they are for a reason. I have hope for our field, in our society, and the broader society.” Dr. Inder has certainly gathered a lot of knowledge and many life lessons throughout her journey, and she leaves you with one final realization. “It is the people in your life, your family, your friends and your colleagues, your patients and their families, that bring you the most joy. It’s a privilege to be able to pursue your passion and be employed to do it.”

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