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Longitudinal Study Tracks Preterm Infants

(Feb 1, 2009)

Preterm infants are at high risk of brain injury and attendant neurological and developmental deficits. Several years ago, doctors at the Division of Newborn Medicine at the Komansky Center for Children's Health/Weill Cornell Medical Center began a program in which MRIs are conducted just prior to discharge for infants whose birth weight is less than 1,000 g, in an attempt to determine which specific or global areas of the brain are affected by preterm birth.

When new algorithms enabled them to use MRI data to measure the volume of different areas of the brain, Jeffrey M. Perlman, MD, Professor of Pediatrics and the Division Chief, and his colleagues initiated a longitudinal study to correlate brain volume measurements with neuropsychological evaluations of those same children as they aged and developed. The results of this study may eventually lead to a greater understanding of the neurological, psychological, and cognitive difficulties that these children are likely to face, which in turn will allow developmental problems to be predicted based on MRI data and pave the way for early interventional programs that may even begin before the infant leaves the hospital.

"We evaluate the children at 18 months (corrected age), at 3 years, and, in time, beyond that," Dr. Perlman said, "and we perform different psychological and psychometric tests. The primary goal is to examine the MRI volumes that we are measuring and try to predict, based on those volumes, what the outcome will be at 3 years. Then, as a second goal, if specific areas of the brain are affected more than other regions, we will try to determine the mechanisms accounting for these differences. As a third goal, we want to determine what factors and/or events during the neonatal intensive care course could account for the specific abnormalities that may be seen on the MRI."

Gail Ross, PhD, Associate Professor of Psychology in Pediatrics and Psychiatry, noted that she and the other testers are blind to the MRI results and other perinatal data on the children they evaluate. "We maintain a database of our results, while Dr. Perlman maintains a database of the perinatal variables and the results of the MRIs taken at birth," she said.

At the 18-month visit, the children are tested in 3 areas: cognitive abilities separate from language, ability to understand language, and ability to communicate using language. Parents also complete a checklist that describes the child's behavior at home and in everyday situations, and the child's behavior during test-taking is described and rated by the tester.

"When children are 3 years old, we administer the Wechsler Preschool and Primary Scale, which is a standardized measure of intelligence, as well as measures of language and behavior," Dr. Ross said. "We hope to see the same children again at 6 years old, at which time we can do more complete assessments of neurocognitive functioning and learning abilities."

Dr. Perlman, who has been studying neonatal brain injury for 25 years, noted that from his research he has come to appreciate the brain's ability to "repair" itself if the conditions are right. "I am becoming more of a strong believer that you can actually induce plasticity and get recovery far in excess of what one may have anticipated, unless the brain injury is very severe," he said. "The moderate cases may become mild and the mild may actually develop normally or be near normal. Those are the aspects that we're focusing on, and as we identify these deficits, we'll begin to implement early targeted intervention strategies as early as possible. We're beginning to raise questions about potential interventions even within the unit before discharge that may improve cognitive outcomes, though more data are still needed."

The longitudinal study began in 2004. Now 18-month (and in some cases 3-year) results are in for the first 40 study participants, and some very interesting patterns are beginning to emerge. "For example, we have already begun to identify certain patterns of consistent early abnormalities related to speech," Dr. Perlman said. "That's not a big surprise, but it's something we really need to focus on. These babies appear to understand but they have difficulty expressing themselves. We’ve got to try to understand the reasons for that. We're trying to understand where we're falling short, and we're trying to fix it."

Jeffrey M. Perlman, MD, is Division Chief of Newborn Medicine, NewYork-Presbyterian Hospital/Weill Cornell Medical Center’s for Children’s Health, and Professor of Pediatrics, Weill Cornell Medical College.

Gail Ross, PhD, is an Associate Attending Psychologist, NewYork-Presbyterian Hospital/ Weill Cornell Medical Center, and an Associate Professor of Psychology in Pediatrics and Psychiatry, Weill Cornell Medical College.

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