Pre-term babies' exposure to steroids associated with impaired brain growth

Premature infants exposed after birth to drugs known as glucocorticoids are at increased risk for having impaired growth of the cerebellum, according to findings from a new UCSF-led study. The cerebellum is a region of the brain associated with balance, motor learning, language and behavior.

The findings challenge the recent policy statement of The American Academy of Pediatrics, which suggests that low doses of glucocorticoids -- a class of steroid hormones used in premature babies to support lung maturation, the normalization of blood pressure and breathing -- can continue to be used in premies. In their 2010 statement, the Academy recommended that high-dose dexamethasone not be given to babies after birth, but stated that the evidence was insufficient to make a recommendation regarding other doses of glucocorticoids.

In the current study, published in the Oct. 19, 2011, issue of Science Translational Medicine, the researchers found that betamethasone given to mothers in premature labor was not associated with adverse affects on the baby's brain growth. However, they found that premature babies given hydrocortisone or dexamethasone in a low-dose range after birth had, on average, 10 percent smaller cerebellar volumes by the time they were full term.

"This study provides new evidence that these drugs, even at low doses, are associated with impaired cerebellar development when given to babies after birth," said Emily Tam, MD, a child neurologist in the Neurological Intensive Care Nursery at the UCSF Benioff Children's Hospital and lead author of the study.

The long-term impacts on cognitive and motor development will need to be assessed through neurological examinations and developmental testing when the children are at school age, she said. However, previous studies have shown that smaller cerebellar volumes in children born prematurely are associated with significant motor and cognitive impairments by teenage years.

Babies born prematurely may be treated with glucocorticoids for a number of reasons. Betamethasone is often given to mothers in preterm labor to accelerate the baby's lung maturation, and either hydrocortisone or dexamethasone may be given to premature newborns after birth to help with maintaining a normal blood pressure or to shorten the period of time they need help with breathing using a breathing tube.

Read more: http://www.eurekalert.org/pub_releases/2011-10/uoc--pbe101711.php

Child Football Helmet Study Underway

Virginia Tech released October 18 results from the first study ever to instrument child football helmets. Youth football helmets are currently designed to the same standards as adult helmets, even though little is known about how child football players impact their heads. This is the first study to investigate the head impact characteristics in youth football, and will greatly enhance the development of improved helmets specifically designed for children.

The Auburn Eagles, a local, Montgomery County, Va., youth team consisting of 6 to 8 year old boys, has participated in the study since August. The helmets of the child football players are instrumented with custom 12 accelerometer arrays that measure how a child's head responds to impact. Each time a player impacts his head, data are recorded and wirelessly downloaded to a computer on the sideline.

The technology is similar to what Virginia Tech has used since 2003 to instrument its collegiate football team. "The research conducted with the Virginia Tech football team has led to a better understanding of head impacts in football and how they relate to concussions," said Stefan Duma, the Virginia Tech professor of biomedical engineering and department head of the Virginia Tech -- Wake Forest University School of Biomedical Engineering and Sciences (SBES) that directs this project.

Furthermore, this research has led to the development of the National Impact Database (http://www.sbes.vt.edu/nid), which contains the first safety rating system ever available for adult football helmets (STAR Evaluation System). Similar developments for youth football are anticipated from the current study with the Auburn Eagles.

"Based on eight years of studying head impacts experienced by Virginia Tech football players, we were able to quantify exposure for adult football players relative to impact location, severity, and frequency," Duma said. "Unfortunately, we cannot translate the adult exposure to the youth helmets because the impact conditions of youth football are completely unknown. To solve this problem, we are applying the same approach that we have used with the Virginia Tech football team to a youth football team," Duma added.

Read more: http://www.sciencedaily.com/releases/2011/10/111018084636

Optimal Modulation of Ion Channels Rescues Neurons Associated With Epilepsy

New research successfully reverses epilepsy-associated pathology by using a sophisticated single-cell modeling paradigm to examine abnormal cell behavior and identify the optimal modulation of channel activity. The study, published by Cell Press in the October 18th issue of Biophysical Journal, describes a procedure that may be useful for rescuing function in organs with excitable cells, such as the heart and pancreas.

Ion channels regulate the flow of ions into and out of the cell and are absolutely critical for a wide range of biological processes, including transmission of signals in the nervous system. Disrupting ion channel function can have disastrous consequences. For example, the severe neurological disorder epilepsy is characterized by spontaneous and recurrent seizures that are thought to be linked with ion channel dysfunction.

Dr. Erik Fransén from the Royal Institute of Technology in Stockholm was interested in examining neuronal excitability at the single-cell level and using sophisticated computational modeling to discover a way to restore normal neuronal function. "We studied ion channel alteration related to epilepsy," explains Dr. Fransén. "Previously, we showed that dysfunction of a specific potassium channel, KA, was linked to synchronicity, one of the key elements of epilepsy. In this current study, we focused on improving the functional behavior of the neuron and reversing pathological changes."

Dr. Fransén and colleagues studied the modulation of KA by substances known to influence channel activation. Sophisticated ion channel simulations allowed the researchers to examine known modulatory substances and to determine the most beneficial concentration of the modulators for reduction of abnormal neuron activity. Importantly, the optimization method revealed specific combinations of modulators that reversed pathological changes in KA observed in a patient with epilepsy.

The authors suggest that the optimization procedure may have widespread application. "The method we developed to functionally correct a pathological neuron can be used for other brain diseases where alterations of ion channels are involved," concludes Dr. Fransén. "It may also be used in other organs with excitable cells, such as the heart or pancreas. For instance, atrial fibrillation is one of the most common sustained cardiac arrhythmias with an underlying pathology of cell hyperexcitability due to, among other things, alterations of ion channels."

Read more: http://www.sciencedaily.com/releases/2011/10/111018121838

Pollutants Linked to 450 Percent Increase in Risk of Birth Defects in Rural China

Pesticides and pollutants are related to a 450 percent increase in the risk of spina bifida and anencephaly in rural China, according to scientists at The University of Texas at Austin and Peking University.

Two of the pesticides found in high concentrations in the placentas of affected newborns and stillborn fetuses were endosulfan and lindane. Endosulfan is only now being phased out in the United States for treatment of cotton, potatoes, tomatoes and apples. Lindane was only recently banned in the United States for treatment of barley, corn, oats, rye, sorghum and wheat seeds.

Strong associations were also found between spina bifida and anencephaly and high concentrations of polycyclic aromatic hydrocarbons (PAHs), which are byproducts of burning fossil fuels such as oil and coal. Spina bifida is a defect in which the backbone and spinal canal do not close before birth. Anencephaly is the absence of a large part of the brain and skull.

"Our advanced industrialized societies have unleashed upon us a lot of pollutants," says Richard Finnell, professor of nutritional sciences and director of genomic research at the Dell Children's Medical Center of Central Texas. "We've suspected for a while that some of these pollutants are related to an increase in birth defects, but we haven't always had the evidence to show it. Here we quite clearly showed that the concentration of compounds from pesticides and coal-burning are much higher in the placentas of cases with neural tube defects than in controls."

The study, which was published in August in the Proceedings of the National Academy of Sciences, is the result of a more than decade-long collaboration between Finnell and a team of researchers in Shanxi, a province in northern China.

Finnell sought collaborators in China because the prevalence of neural tube defects is much greater there than it is in the United States. Also, because of its population policies, China is good at tracking births.

"It's an extraordinary natural experiment," says Finnell, who was recently recruited to the university to help anchor the Dell Pediatric Research Institute. "It would be much harder to do this study in the United States, where neural tube defects are more rare. It's also an opportunity to assist the Chinese government in their efforts to lower their birth defect rates."

Read more: http://www.sciencedaily.com/releases/2011/10/111019185134

Newborn preemies more vocal when parents are near

Even tiny preemies hospitalized after birth can make baby sounds -- especially when their parents are talking to them, a small study suggests.

Very premature babies are known to be slower-than-average in picking up language skills. That can be due to various reasons, including health problems they may have as newborns.

It's not known whether the sounds preemies hear soon after birth, and their own ability to vocalize, are related to their later language development. But premature infants who spend their early days in the neonatal intensive care unit (NICU) are in a much different sound environment than they would be if still in the womb, said Dr. Melinda Caskey, a pediatrician at Women and Infants Hospital in Providence, Rhode Island, and the lead researcher on the new study.

In the womb, mom's voice is the most prominent sound, Caskey said. In the NICU, the beeps and whirs of medical equipment abound.

Until now, though, no studies had looked at how much language NICU preemies hear during their day.

Caskey's team found that in their hospital NICU, it was surprisingly little -- with monitor sounds, general noise and silence being much more common.

"It's very striking," Caskey told Reuters Health, "especially when you compare that with what the fetus hears."

What's more, the study found, when preemies were hearing adults talk -- their parents, in particular -- they were more vocal themselves. That usually meant making short vowel sounds.

Read more: http://www.baltimoresun.com/health/sns-rt-us-newborn-preemiestre79j5ki-20111020,0,6665194.story

October 19, 2011

An Ordinary Football Game, Then a Player Dies

By JORGE CASTILLO

PHOENIX, N.Y. — Football coaches and school administrators at John C. Birdlebough High School congregated in a small room off the library Monday, huddling around a computer for a most painful and unusual review of game video. They examined every play that one student was involved in, assuming the role of medical examiners.

They were trying to discern which collision of the hundreds in a football game at Homer High School on Friday night might have caused Ridge Barden, a 16-year-old defensive tackle, to fall to the turf in the third quarter and die within a few hours. The coroner attributed Barden’s death to a subdural hematoma, or a brain bleed.

“There’s nothing here; there’s still nothing there; there’s nothing there; there’s nothing there — and now he’s laying on his stomach,” Jeff Charles, the head coach, said while watching the sequence frame by frame.

As those who play and coach football learn new ways to improve safety — through training, medical response and equipment — sometimes they are left to contemplate this: brains remain vulnerable, and even the most ordinary collisions on the field can kill.

Teenagers are especially susceptible to having multiple hits to the head result in brain bleeds and massive swelling, largely because the brain tissue has not yet fully developed. According to the National Center for Catastrophic Sport Injury Research, Barden was the 13th high school player to die from a brain injury sustained on a football field since 2005 and the third this year. Including college and youth football players, there have been 18 fatalities since 2005.

With heightened attention focused on brain injuries in football in recent years, Barden’s death delivered an unwelcome reminder that even the best-known practices sometimes fall short. As it happened, the Senate Commerce Committee, the latest group in Washington to explore the topic, held a hearing Wednesday to discuss concussions in sports and the controversial marketing of “anticoncussion” equipment.

Barden had no history of head trauma and showed no concussion symptoms, his coaches and father said. The Cortland County coroner’s office said the autopsy showed no evidence of a pre-existing problem.

Barden’s helmet, a Riddell Revolution, was purchased by the school two years ago directly from Riddell. It was reconditioned after last season and recertified for use in 2011 by Stadium System, a company based in Canaan, Conn., that reconditions helmets for hundreds of schools around the country.

Two certified athletic trainers and three student trainers from the nearby State University of New York at Cortland were on hand and treated Barden on the field, and emergency medical technicians arrived with an ambulance within minutes.

“You can have the perfect plan in place but if all of these things happen, it can still result in a catastrophic injury and death,” said Kevin Guskiewicz, the chairman of the department of exercise and sports science at the University of North Carolina and a leading researcher on sports concussions.

Dr. Jeffrey Kutcher, director of the Michigan NeuroSport concussion program at the University of Michigan, was among the witnesses who testified at the Senate hearing Wednesday. “Those kind of injuries are very rare, they’re catastrophic, they will happen and there’s no real way of preventing them through equipment,” he said about Barden’s death in an interview after the hearing. “That’s going to happen any time there are impacts to the head of significant force.”

After reviewing the video, the coaching staff deduced that the critical blow was sustained on Barden’s second-to-last play, a routine collision with an opposing lineman at the line of scrimmage. But Barden appeared to be fine as he prepared for the next play.

At first, after collapsing, he was groggy but responsive and coherent, Mr. Charles said. Barden told his coach that he had sustained a helmet-to-helmet hit and that his head hurt. Barden rolled over on his back then sat up on his own, but his condition quickly deteriorated. He began moaning and closing his eyes. When asked to stand up, he tried but immediately collapsed.

The emergency technicians planned to take Barden to University Hospital in Syracuse, about 45 minutes away, but they rerouted when Barden went into cardiac arrest. While the crew performed CPR, the ambulance drove three minutes to Cortland Medical Center instead.

When Barden’s father and grandmother arrived from Phoenix, the doctor told them he was dying; only CPR was keeping him alive. At 10:18 p.m., less than two hours after the seemingly ordinary play at the 6-yard line, Barden was pronounced dead.

Dr. Guskiewicz said the only way Barden might have been saved from a subdural hematoma would have been if he had undergone immediate surgery to relieve the pressure on his brain. But a CT scan would have been needed to diagnose the problem, and, according to accounts, Barden’s condition deteriorated too quickly for him to have a CT scan.

Dr. Robert Cantu, a neurosurgeon at Boston University and a leading expert in sports-related head injuries, said that in cases similar to Barden’s, in which the person was conscious right after the hit before quickly deteriorating, he had discovered that the subdural hematoma was not the cause of death but rather massive brain swelling. And in many cases the condition began with a previous hit and a second impact was the lethal blow.

Dr. Cantu said he could not speak to the particulars of Barden’s case without examining the brain.

“All I can simply say is that when I see this precipitous deterioration, my ears immediately go up and I wonder about second-impact syndrome in association with subdural hematoma,” Dr. Cantu said, adding that an original blow can be sustained off the field. “But it’s the second impact that’s the lethal part.”

Students, coaches and administrators remembered Barden this week as a straight-A student who would walk a long way from his home to school for voluntary workouts in the summer. Friday night’s game was his first start with the varsity team.

The community was left wondering what could have been done differently. The coach, Mr. Charles, contemplated whether he could return to coaching football. His team’s last game of the season has been canceled.

“I will never bad-mouth the sport of football,” Mr. Charles said. “I played it and I loved it and I’ve coached for years, but it does make me take a second look at it.

“I’ve had a few people asking if I’d coach again, and you know what, I don’t know. Right now I think the irrational thing would be to say: ‘No, I don’t feel like coaching again. It scares me.’ But to be honest, I don’t know how it’s going to affect my coaching. It scares me right now that I don’t know if I will be a good coach.”

Barden’s father, Jody, said he had no objection to the sport in the wake of his son’s death.

“I just don’t want a negative spin on this,” Mr. Barden said Sunday. “There is no blame in this. I don’t want to scare kids from playing the game. Ridge loved playing the game, and I know he wouldn’t want it to get a bad name.”

Risk of Autism Is Five Times Higher in Low-Birthweight Babies

Low-birthweight babies are at risk for all sorts of motor and cognitive delays, and researchers have just added autism to the list. A new study from the University of Pennsylvania finds that premature babies weighing less than 4.5 lbs. at birth are five times more likely than babies born at a normal weight to have an autism spectrum disorder (ASD).

Routine screening for ASD is especially critical in light of medical advances that regularly save babies as little as 1 lb. "It's a public health red flag," says Jennifer Pinto-Martin, director of the Center for Autism and Developmental Disabilities Research and Epidemiology at the University of Pennsylvania (Penn) and the study's lead author. "We have a wave of these children coming down the pike because neonatal care has improved so dramatically. We are saving more and more babies, and the consequences for their health are going to be profound."

The conclusions, which are published Monday in the journal Pediatrics, are the results of a study that began more than two decades ago. Researchers initially followed 1,105 children who were born in three New Jersey counties between 1984 and 1987, some of whom weighed just a pound at birth.

Researchers evaluated the children at ages 2, 6, 9, 16 and 21, looking each time at different outcomes — behavioral, academic and psychiatric, to name a few. At age 16, they screened the children for autism. What they found was surprising: 117 of the 623 children screened positive, while 506 screened negative.

"It was very high, and we thought we had a great opportunity to really evaluate them for autism with a diagnostic test," says Pinto-Martin, who is also a professor in the School of Nursing at Penn.

That's exactly what Martin did when the preemies turned 21. She was able to catch up with 70 of the 117 who had screened positive and 119 of the 506 who had been negative. It was important to evaluate both groups thoroughly using diagnostic tests because screening tools are not 100% accurate.

They wound up with a total of 14 cases of ASD, which equates to five times the rate of autism reported in the general population. "CDC data says it's about 1% in 8-year-olds, and we found it to be 5% in 21-year-olds," says Pinto-Martin.

Read more: http://healthland.time.com/2011/10/17/risk-of-autism-is-five-times-greater-in-low-birthweight-babies/#ixzz1b97Nzyfw

Read the Science Daily article: http://www.sciencedaily.com/releases/2011/10/111017092239