What research is being carried out to improve the early prediction of later disabilities in the highest risk newborns? 2/2006 

SUMMARY:
Internationally, researchers are engaged in developing noninvasive methods for identifying infants who are likely to later show developmental delays, impairments and disabilities. Most neuroscientists and clinicians agree that the human brain possesses great potential for plasticity and that experience can modify development.

Furthermore, pharmacologic and cellular interventions to improve the nervous system damage present in cerebral palsy and other conditions that lead to abnormalities in brain development are on the horizon. Early detection will some day allow early intervention. For these reasons, and to prepare families and caregivers, early prediction of later impairment is critically important.

A cautionary note, however, is necessary. Early abnormalities in diagnostic tests can prove to be “false positives”. In other words, such abnormal findings on tests could end up giving children labels that later prove inaccurate. So, although in theory, early diagnoses would allow for early intervention when the brain is most plastic, these findings are not yet ready for incorporating into pediatric practice.

Some children with substantial abnormalities present on brain imaging will ultimately grow into healthy adults and some with completely normal looking magnetic resonance imaging will have substantial impairment from cerebral palsy.

Nonetheless, accurate early detection will eventually be available and will no doubt be very helpful for diagnosis, prognosis and to guide earliest intervention. It is an area of science that begs further investigation.

Literature: Imaging Technologies

Pediatricians and neurologists in Boston are using magnetic resonance imaging to study the brains of neonates¹. At this stage, they have been able to show that it is possible, using volumetric diffusion tensor magnetic resonance imaging and adapting algorithms currently used for adult studies, to accurately visualize 3-dimensional structures of cerebral white matter fiber tracts in preterm infants and full term infants (as young as 28 weeks postconceptional age). White matter fiber bundles from the genu and the splenium of corpus callosum, the corticospinal tracts, the inferior fronto-occipital fasciculi, and optic radiations were visualized.

Comment:
What does this mean? What is remarkable about this work is that such detail is now visible, despite the very small amount tissue present in these infants. Magnetic resonance imaging is steadily improving, allowing clinicians to look inside the body with extraordinary clarity and accuracy. Technical advancements in the equipment and in the computer programs that analyze the images, it is possible to look into the tiny brain of the premature infant and see not only gross abnormalities (such as enlarged ventricles or evidence for bleeding) but detailed neuroanatomy. It is possible to see specific bundles of nerves (axons) which transmit information about movement, sensation, vision, hearing and other critical functions. Very soon it may be possible to identify abnormally developing pathways. Long term follow-up studies will be necessary to determine the clinical importance of the white matter changes imaged in this manner.