Study: Premature birth linked to altered brain connectivity and developmental disorders

According to a recent study, premature birth is linked to altered brain connectivity.- JR

Premature birth can alter the connectivity between key areas of the brain, according to a new study led by King's College London. The findings should help researchers to better understand why premature birth is linked to a greater risk of neurodevelopmental problems, including autistic spectrum disorders and attention deficit disorders.

The NIHR-funded study, published in the journal PNAS, used functional magnetic resonance imaging (fMRI) to look at specific connections in the brains of 66 infants, 47 of whom were born before 33 weeks and were therefore at high risk of neurological impairment, and 19 born at term. The brain connections investigated were between the thalamus and the cortex, connections which develop rapidly during the period a preterm infant is cared for on a neonatal unit.

Researchers found that those born in the normal window of birth (37-42 weeks) showed a remarkably similar structure to adults in these brain regions, strengthening existing evidence that the brain's network of connections is quite mature at the time of birth.

However, infants born prematurely (before 33 weeks gestation) were found to have less connectivity between areas of the thalamus and particular areas of the brain's cortex known to support higher cognitive functions, but greater connectivity between the thalamus and an area of primary sensory cortex which is involved in processing signals from the face, lips, jaw, tongue, and throat.

The greater the extent of prematurity, the more marked were the differences in the pattern of brain connectivity.

The authors suggest that the stronger connections involving face and lips in babies born preterm may reflect their early exposure to breastfeeding and bottlefeeding, while the reduced connectivity in other brain regions may be linked to the higher incidence of difficulties seen in later childhood.

Dr Hilary Toulmin, first author from the Centre for the Developing Brain at King's College London, said: 'The next stage of our work will be to understand how these findings relate to the learning, concentration and social difficulties which many of these children experience as they grow older.'

Professor David Edwards, senior author from the Centre for the Developing Brain at King's College London, said: 'The ability of modern science to image the connections in the brain would have been inconceivable just a few years ago, but we are now able to observe brain development in babies as they grow, and this is likely to produce remarkable benefits for medicine.'

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Study: Pregnant women with PTSD more likely to give birth early

A study found that pregnant women with PTSD are more likely to give birth early.

Pregnant women with post-traumatic stress disorder are at increased risk of giving birth prematurely, a new study from the Stanford University School of Medicine and the U.S. Department of Veterans' Affairs has found.

The study, which examined more than 16,000 births to female veterans, is the largest ever to evaluate connections between PTSD and preterm birth.

Having PTSD in the year before delivery increased a woman's risk of spontaneous premature delivery by 35 percent, the research showed. The results will be published online Nov. 6 in Obstetrics & Gynecology.

"This study gives us a convincing epidemiological basis to say that, yes, PTSD is a risk factor for preterm delivery," said the study's senior author, Ciaran Phibbs, PhD, associate professor of pediatrics and an investigator at the March of Dimes Prematurity Research Center at Stanford University. "Mothers with PTSD should be treated as having high-risk pregnancies."

Spontaneous preterm births, in which the mother goes into labor and delivers more than three weeks early, account for about six deliveries per 100 in the general population. This means that the risk imposed by PTSD translates into a total of about two additional premature babies for every 100 births. In total, about 12 babies per 100 arrive prematurely; some are born early because of medical problems for the mother or baby, rather than because of spontaneous labor.

A piece of the prematurity puzzle

"Spontaneous preterm labor has been an intractable problem," said Phibbs, noting that rates of spontaneous early labor have barely budged in the last 50 years. "Before we can come up with ways to prevent it, we need to have a better understanding of what the causes are. This is one piece of the puzzle."

Doctors want to prevent prematurity because of its serious consequences. Premature babies often need long hospitalizations after birth. They are more likely than full-term babies to die in infancy. Many of those who survive face lasting developmental delays or long-term impairments to their eyesight, hearing, breathing or digestive function.

Phibbs' team analyzed all deliveries covered by the Veterans Health Administration from 2000 to 2012, a total of 16,344 births. They found that 3,049 infants were born to women with PTSD diagnoses. Of these, 1,921 births were to women with "active" PTSD, meaning the condition was diagnosed in the year prior to giving birth, a time frame that the researchers thought could plausibly affect pregnancy.

The researchers examined the effects of several possible confounding factors. Being older, being African-American or carrying twins all increased the risk of prematurity, as extensive prior research has shown.

The researchers also looked at the effects of maternal health problems (high blood pressure, diabetes and asthma); possible sources of trauma (deployment and military sexual trauma); mental health disorders other than PTSD; drug or alcohol abuse; and tobacco dependence. However, these factors had little influence on risk for premature birth.

The effect of stress

In other words, although pregnant women with PTSD may have other health problems or behave in risky ways, it's the PTSD that counts for triggering labor early.

"The mechanism is biologic," Phibbs said. "Stress is setting off biologic pathways that are inducing preterm labor. It's not the other psychiatric conditions or risky behaviors that are driving it."

However, if a woman had been diagnosed with PTSD in the past but had not experienced the disorder in the year before giving birth, her risk of delivering early was no higher than it was for women without PTSD. "This makes us hopeful that if you treat a mom who has active PTSD early in her pregnancy, her stress level could be reduced, and the risk of giving birth prematurely might go down," said Phibbs, adding that the idea needs to be tested.

Although PTSD is more common in military veterans than the general population, a fairly substantial number of civilian women also experience PTSD, Phibbs noted. "It's not unique to the VA or to combat," he said, noting that half of the women in the study who had PTSD had never been deployed to a combat zone. "This is relevant to all of obstetrics."

The VA has already incorporated the study's findings into care for pregnant women by instructing each VA medical center to treat pregnancies among women with recent PTSD as high-risk. And Phibbs' team is now investigating whether PTSD may also contribute to the risk of the mother or baby being diagnosed with a condition that causes doctors to recommend early delivery for health reasons.

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Brain abnormalities seen in late pre-term infants

A study looked into MRI scans of late pre-term infant and found that they have brain abnormalities.

Babies born 32 to 36 weeks into gestation may have smaller brains and other brain abnormalities that could lead to long-term developmental problems, according to a new study published online in the journal Radiology.

Much of the existing knowledge on preterm birth and brain development has been drawn from studies of individuals born very preterm, or less than 32 weeks into gestation at birth.

For the new study, researchers in Australia focused on moderate and late preterm (MLPT) babies -- those born between 32 weeks, zero days, and 36 weeks, six days, into gestation. MLPT babies account for approximately 80 percent of all preterm births and are responsible for much of the rise in the rates of preterm birth over the last 20 years. Despite this, to date there have been no large-scale studies published on brain alterations associated with MLPT birth that may provide insight into brain-behavior relationships in this group of children.

"In those very preterm babies, brain injury from bleeding into the brain or a lack of blood flow, oxygen or nutrition to the brain may explain some of the abnormal brain development that occurs," said the study's lead author, Jennifer M. Walsh,M.B.B.Ch., B.A.O., M.R.C.P.I., from the Royal Women's Hospital in Melbourne, Australia. "However, in some preterm babies, there may be no obvious explanation for why their brain development appears slow compared with babies born on time."

To learn more, the researchers performed magnetic resonance imaging (MRI) exams on 199 MLPT and 50 term-born infants (greater than 37 weeks gestation) between 38 to 44 weeks of gestation. They looked for signs of brain injury and compared the size and maturation of multiple brain structures in the two groups.

While injury rates were similar between the two groups, MLPT birth was associated with smaller brain size at term-equivalent age. In addition, MLPT infants had less developed myelination in one part of the brain and more immature gyral folding compared with term-born controls. Myelination -- the formation of a fatty insulating sheath around some nerve fibers -- and gyral folding -- the folding of the cerebral cortex to increase the brain's surface area -- are important processes in early brain development.

The findings suggest that MLPT birth may disrupt the expected trajectory of brain growth that would normally occur in the last two or so months in utero, according to Dr. Walsh.

"Given that brain growth is very rapid in the last one-third of pregnancy, it is perhaps not surprising that being born during this potentially vulnerable period may disrupt brain development," she said. "Brain growth is very complex, involving not only the neurons with which we think and do things, but also the other brain cells that support the neurons and are vital for normal brain function."

The researchers are hoping to learn in greater depth the impact that moderate to late preterm birth has on the brain, so that they can then begin to try different treatments designed to improve brain function and long-term outcome in these infants.

"Medications, along with early intervention to help parents understand their baby's needs, have been effective in helping very preterm babies catch up to their term-born peers," Dr. Walsh said. "However, whether any of the existing treatments will help babies born between 32 and 36 weeks is unknown, as they have not been studied very much at all."

The researchers plan to follow the infants in the study group through childhood to learn more about the relationship between brain abnormalities and later outcomes. They also are assessing additional MRI information about brain structure and function in these children.

"Understanding what problems they have and what might be causing them is the first step in trying to improve their long-term outcome," Dr. Walsh said.

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Skin to Skin with Premature Babies - Better Brain Function

Preemies' Brains Reap Long-Term Benefits from Kangaroo Mother Care

Sep. 19, 2012 — Kangaroo Mother Care -- a technique in which a breastfed premature infant remains in skin-to-skin contact with the parent's chest rather than being placed in an incubator -- has lasting positive impact on brain development, revealed Université Laval researchers in the October issue of Acta Paediatrica. 

Very premature infants who benefited from this technique had better brain functioning in adolescence -- comparable to that of adolescents born at term -- than did premature infants placed in incubators.

Earlier research showed that infants born prior to the 33rd week of pregnancy experienced more cognitive and behavioral problems during childhood and adolescence. Université Laval researchers Cyril Schneider and Réjean Tessier, of the Department of Rehabilitation in the Faculty of Medicine and of the School of Psychology, respectively, and their Colombian colleagues Nathalie Charpak (Kangaroo Foundation) and Juan Ruiz-Peláez (Universidad Javeriana) wanted to determine if Kangaroo Mother Care could prevent these problems. To that end they compared, at age 15, 18 premature infants kept in incubators, 21 premature infants held in Kangaroo contact for an average of 29 days, and 9 term infants.

To assess participants' brain functions, the researchers used transcranial magnetic stimulation. With this non-invasive and painless technique they could activate brain cells in targeted areas, namely the primary motor cortex that controls muscles. By measuring muscle responses to the stimulation, they were able to assess brain functions such as the level of brain excitability and inhibition, cell synchronization, neural conduction speed, and coordination between the two cerebral hemispheres.
The data collected by the researchers indicate that all brain functions of the adolescent Kangaroo group were comparable to those of the term infant group. On the other hand, premature infants placed in incubators significantly deviated from the other two groups 15 years after their birth.

"Thanks to Kangaroo Mother Care, infants benefited from nervous system stimulation -- the sound of the parent's heart and the warmth of their body -- during a critical period for the development of neural connections between the cerebral hemispheres. This promoted immediate and future brain development," suggests neurophysiologist Cyril Schneider.

http://www.sciencedaily.com/releases/2012/09/120919125600.htm

Study: Preemies from Low-Income Families at High Risk for Dangerous Brain Bleeds

A study from Johns Hopkins shows that premies who are born to a low socioeconomic family are more likely to have dangerous hemorrhages.

While interesting, I never know how to apply this data in the office, the NICU or my cerebral palsy clinics.... JR

Babies born prematurely to low-income parents have a disproportionately high risk for developing dangerous brain bleeds that require multiple surgeries and extensive follow-up, according to a small Johns Hopkins Children's Center study.

The findings -- published online Sept. 28 in the journal Pediatric Neurosurgery and based on an analysis of 38 patients referred to Johns Hopkins for treatment of brain hemorrhages related to premature birth -- offer a sobering reminder of the role socio-economic factors can play in health outcomes, the researchers say.

The link between poverty and premature birth has been well-documented, the investigators say, but the new findings go a step further and focus on the consequences of one particularly dire and fairly common complication of prematurity -- brain hemorrhages.

"Our study shows just how detrimental and far-reaching the effects of prematurity can be, medically and otherwise, highlighting the critical need to better identify high-risk pregnancies and reduce the number of premature births," says Edward Ahn, M.D., pediatric neurosurgeon and senior author on the research.

"Brain hemorrhages can have a lifelong impact on a child's neurological and cognitive development, but also create a financial burden on the families, many of whom in our study were already economically challenged," Ahn adds.

The premature brain's blood vessels are highly vulnerable to rapid changes in blood and brain pressure that occur around birth. While some brain bleeds are small and contained within the blood vessel, others can spread further and significantly damage the brain, particularly if not diagnosed and treated promptly. Serious hemorrhages require surgery, intensive follow-up and, often, long-term care to deal with the neurological and developmental after-effects of the condition.

The study tracked 38 babies treated at Hopkins Children's between 2007 and 2010 for complications of brain hemorrhages they had suffered during preterm birth. Most infants in the study (65 percent) were from low-income families and received public health insurance(63 percent). Household income is not part of a standard medical record, but the researchers used zip code and Medicaid status as proxies for income. Medicaid is the public health insurance program for low-income children.

In addition to the higher risk for brain bleeds, the study showed babies from lower-income homes and those with public health insurance had fewer scheduled follow-up appointments and more emergency room visits, compared with babies with private health insurance and with those from higher income homes. The researchers note the differences were clear, even though they didn't reach statistical significance due to the small number of patients in the study.

"If a family foregoes a scheduled follow-up and instead ends up in the ER with a serious, yet likely preventable complication, the medical and financial consequences can be far worse not only for the family but for the health care system as a whole because ER care is more expensive than routine check-ups," Ahn says.

The investigators said their findings need to be replicated on a wider scale in order to further tease out the reasons behind the disproportionate risk.

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Anxiety in adolescents born preterm or with very low birthweight: a meta-analysis of case–control studies

Anxiety in adolescents born preterm or with very low birthweight: 

a meta-analysis of case-

control studies

 Method  We used a systematic review and meta-analysis. We searched the databases ISI Web of Knowledge, PubMed, PsycNET, Educational Resources Information Center (ERIC), Latin American and Caribbean Literature on the Health Sciences (LILACS), and Virtual Health Library (VHL) with equivalent search expressions (from the databases’ inception to June 2011). Also, we screened reference lists of identified articles. We selected case–control studies of adolescents 11 to 20 years old who were very preterm/VLBW and had a matched reference group born at term with normal birthweight that reported a validated anxiety outcome measure. For data extraction, two authors independently reviewed titles, abstracts, and full articles identified through the searches. Subsequently two authors independently extracted data.

Results  We included six studies with 1519 adolescents (787 very preterm/VLBW, 732 comparisons). The general risk of developing clinically significant anxiety problems was nearly doubled (p<0 .05=".05" 1.15="1.15" 2.27="2.27" 5.5="5.5" 9.9="9.9" 95="95" and="and" comparison="comparison" confidence="confidence" group.="group." group="group" in="in" interval="interval" overall="overall" p="p" population="population" preterm="preterm" prevalences="prevalences" the="the" very="very" were="were">

Interpretation  Those born very preterm/VLBW have an increased risk of developing clinically significant anxiety problems in adolescence.

Pediatric Asthma, Pulmonary & Sleep Specialist Serves Houston Suburbs with Personal Attention - Dr. Sarat Susarla joins Texas Medical & Sleep Specialists

Houston is the fourth-largest city in the country, but the suburbs continue to face a shortage of full-time pediatric specialists. Texas Medical & Sleep Specialists proudly announces that Dr. Sarat Susarla has stepped into that void to meet the needs both of infants as well as children/teens with asthma and other lung disorders.

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Working closely with families and primary care doctors while providing timely access, we can make a difference.

Houston, TX (PRWEB) July 23, 2012

Imagine driving your distressed child with asthma through 1 to 2 hours of traffic to see her specialist. Until the summer, patients and families had to face an hour or more traffic to access pediatric specialists in the Houston medical center. No more.

Texas Medical & Sleep Specialists is proud to announce that Dr. Sarat Susarla has joined our practice to provide both pediatric pulmonary & asthma care as well as sleep medicine services to the Greater Houston area.

With dual board certification in pediatric pulmonology and sleep medicine, Dr. Susarla cares for young people with a wide spectrum of respiratory disorders. Dr. Susarla welcomes consultation for infants, children, and young adults with asthma, chronic cough, wheezing, pneumonia, exercise intolerance, and respiratory problems related to prematurity.

Dr Susarla brings an expert perspective to asthma care, “I want to work with parents and community physicians to get children with asthma out of the hospital and emergency room. Working closely with families and primary care doctors while providing timely access, we can make a difference.”, said Susarla.

A pediatric pulmonologist specializes in a wide range of common and rare respiratory disorders. Dr. Susarla describes the scope of his work “Asthma is very common, but chronic respiratory problems in kids can have numerous causes. Sometimes children have symptoms very similar to asthma, but it turns out their real diagnosis is actually very different.”

Dr. Susarla offers advanced onsite lung function testing, exercise testing, as well as same-day urgent appointments. Dr. Susarla is the only private pediatric pulmonologist serving The Woodlands, Sugar Land and Memorial / West Houston area. He has staff privileges at a number of local hospitals including Texas Children's Hospital, Children's Memorial Herman Hospital, and The Woman's Hospital of Texas.

Dr. Susarla serves many of Houston's neonatal intensive care units assisting in complex cases and easing the transition to home. One of his special areas of expertise is apnea and in infancy and chronic respiratory disease in former premature infants.

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