Author: Nancy Fliesler

Protecting the brain in newborn bloodstream infections

NICU%20baby-Shutterstock-cropped

Preterm infants in neonatal intensive care units, particularly those with catheters and intravenous lines, are at high risk for bacteremia—bloodstream infections that can cause lasting brain injury. A new study may change how people think about these infections, suggesting that inflammation is as important to address as the infection itself.

Using a novel mouse model of bloodstream infections in newborns, infectious disease physician-researcher Ofer Levy, MD, PhD, demonstrates that bacteremia can damage the brain even when the bacteria don’t actually get into the central nervous system. Findings were published online last week in the Journal of Infectious Diseases.

“There has been a lot of indirect epidemiologic evidence for a link between bacteremia, inflammation and cerebral injury, but it showed only a correlation, not causation,” says Levy. “Here we demonstrate directly in an animal model that inflammation alone can cause brain injury in newborns with bacteremia, even without entry of the bacteria to the central nervous system.”

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Early neglect and deprivation change the body’s stress response systems

Photo: Angela Catlin/Wikimedia Commons
Photo: Angela Catlin/Wikimedia Commons

Severe social and emotional deprivation in early life is written into our biochemical stress responses. That’s the latest learning from the long-running Bucharest Early Intervention Project (BEIP), which began in 2000 and has been tracking severely neglected Romanian children in orphanages. Some of these children were randomly picked to be placed with carefully screened foster care families, and they’ve been compared with those left behind ever since.

While studies in rodents have linked early-life adversity with hyper-reactivity of the sympathetic nervous system and the hypothalamicpituitaryadrenal (HPA) axis, the relationship has been harder to pin down in humans. BEIP’s study, involving almost 140 children around the age of 12, had children perform potentially stressful tasks, including delivering a speech before teachers, receiving social feedback from other children and playing a computer game that malfunctioned partway through.

Unlike the rodents, the institutionalized children had blunted responses in the sympathetic nervous system, which is associated with the “fight or flight” response, and in the HPA axis, which regulates production of the stress hormone cortisol. The researchers note that this dulled physiologic response has been linked to health problems, including chronic fatigue, pain syndrome and auto-immune conditions, as well as aggression and behavioral problems.

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BabySee: Mobile app lets you see through an infant’s eyes

David Hunter, MD, PhD, chief of Ophthalmology at Boston Children’s Hospital, gets a lot of questions from parents, but the number one question is: “What can my baby see?”

That depends. How old is the baby?

Five days after birth, she might see something like the image at left; at 3 months, the image at right:

BabySee 5 days and 3 mos

At 6 months and 9 months, there’s increasing color and resolution:

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On the clock: Circadian genes may regulate brain plasticity

brain circadian rhythmsIt’s long been known that a master clock in the hypothalamus, deep in the center of our brain, governs our bodily functions on a 24-hour cycle. It keeps time through the oscillatory activity of timekeeper molecules, much of which is controlled by a gene fittingly named Clock.

It’s also been known that the timekeeper molecules and their regulators live outside this master clock, but what exactly they do there remains mysterious. A new study reveals one surprising function: they appear to regulate the timing of brain plasticity—the ability of the brain to learn from and change in response to experiences.

“We found that a cell-intrinsic Clock may control the normal trajectory of brain development,” says Takao Hensch, PhD, a professor in the Departments of Molecular and Cellular Biology and Neurology at Harvard University and a member of the F.M. Kirby Neurobiology Center at Boston Children’s Hospital.

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What we’ve been reading: Week of April 6, 2015

What we've been readingExome sequencing comes to the clinic (JAMA)
An approachable and thorough summary of the growing trend, describing the ways in which sequencing can help provide a diagnosis, the diagnostic yield (as high as 40 percent or more, depending on the population), how often the results have changed treatment decisions and the question of who pays.

Who Owns CRISPR? (The Scientist)
Excellent coverage of the escalating patent scramble for genome editing.

Doctors Make House Calls On Tablets Carried By Houston Firefighters (NPR)
Interesting use of telemedicine in Houston, where many people call 911 in non-emergency situations. EMTs carry tablets, and can have callers chat with a physician on a video app, avoiding the need to take them to the ED.

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Boston Children’s to host second annual Innovators’ Showcase

Ten or more monitors keep track of every child in the ICU. How can clinicians manage all the data they provide?  Surgical Sam beating heart pediatric trainer mannequin simulation Simulator Program The Chamberlain GroupA prototype of the warming pad. The white color indicates that the pad's "phase-change" material is in its solid state. (Courtesy of Anne Hansen)Silk worms could create tissues needed for urinary tract reconstruction.

 

(Clockwise from top: T3, Surgical Sam, non-electric baby warmer, silk-based organ reconstruction)

Next week—on April 15—Boston-area visitors can sample inventions and technologies from around Boston Children’s Hospital, some in development and some already in use. More than 20 medical innovations will be on display in an interactive “science fair” format. We’ll be demonstrating a variety of medical devices, mobile applications, software IT innovations, wearables and bioengineering innovations. It’s free and open to the public.

The event is hosted by Boston Children’s Innovation Acceleration Program and Technology & Innovation Development Office, from 2 to 4 p.m., followed by networking time (4 to 5 p.m.).

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DNA sequencing in newborns: Where do we go from here?

newborn DNA sequencingCan sequencing of newborns’ genomes provide useful medical information beyond what current newborn screening already provides? What results are appropriate to report back to parents? What are the potential risks and harms? How should DNA sequencing information be integrated into patient care?

Four teams from across the country will converge this week (April 8–10) in Kansas City, Mo., to address these questions and share learnings from NIH-funded pilot projects. The four teams, comprising the NIH’s Newborn Sequencing In Genomic medicine and public HealTh (NSIGHT) project, will give updates on their work at the 6th Annual Pediatric Genomics Conference, hosted by Children’s Mercy Kansas City.

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Show me the money: Reimbursement for medical innovations

medical device reimbursementDevice developers tend to focus on the FDA approval process—PMAs and 510(k) clearances—while overlooking another major challenge: getting insurers to cover the device. Before approaching investors, and certainly before doing any studies, keep payers in mind, advises Maren Anderson, president of MDA Consulting, Inc., which specializes in reimbursement planning.

In the old days, doctors prescribed, and insurers paid. Under health care reform, that’s changed, says Anderson.

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New Human Neuron Core to analyze ‘disease in a dish’

Human Neuron CoreLast week was a good week for neuroscience. Boston Children’s Hospital received nearly $2.2 million from the Massachusetts Life Sciences Center (MLSC) to create a Human Neuron Core. The facility will allow researchers at Boston Children’s and beyond to study neurodevelopmental, psychiatric and neurological disorders directly in living, functioning neurons made from patients with these disorders.

“Nobody’s tried to make human neurons available in a core facility like this before,” says Robin Kleiman, PhD, Director of Preclinical Research for Boston Children’s Translational Neuroscience Center (TNC), who will oversee the Core along with neurologist and TNC director Mustafa Sahin, MD, PhD, and Clifford Woolf, PhD, of Boston Children’s F.M. Kirby Neurobiology Center. “Neurons are really complicated, and there are many different subtypes. Coming up with standard operating procedures for making each type of neuron reproducibly is labor-intensive and expensive.”

Patient-derived neurons are ideal for modeling disease and for preclinical screening of potential drug candidates, including existing, FDA-approved drugs. Created from induced pluripotent stem cells (iPSCs) made from a small skin sample, the lab-created human neurons capture disease physiology at the cellular level in a way that neurons from rats or mice cannot.

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Melanopsin, lighting and you

color spectrum melanopsin
A deep-dive view of non-image vision may refine our understanding of light and health.

Back in the day, the 1980s to be specific, there was a brief fad around amber-on-black computer screens (as opposed to green-on-black or white-on-black) for supposed ergonomic reasons. My computer had one, along with its 5 ¼” floppy drives (remember those?).

More recently, with kids texting at night and people logging late hours on computers and devices, there’s been a recognition that artificial light at night is bad for sleep and disruptive to physiology overall, with blue light increasingly recognized as the culprit.

That’s given birth to some new fads. You can now download programs to eliminate blue light from your computer screen at night or buy amber-tinted glasses for computing and gaming to “filter the harsh spectra” of light. Airlines are using “mood” lighting to mimic sunrises and sunsets, which supposedly reduces jetlag.

In a paper in Neuron last week, Alan Emanuel and Michael Do, PhD, of the F.M. Kirby Neurobiology Center at Boston Children’s Hospital and Harvard Medical School provide some science to support and inform these fads, as well as the use of light therapy for conditions like seasonal affective disorder.

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