Stories about: newborn medicine

Telemedicine brings expert blindness screenings to preemies

ROP screening in the NICU
Gretchen Hamn (L) and Margie Young screen a premature infant for retinopathy of prematurity. (Photos: Katherine C. Cohen)

We’re in the Neonatal Intensive Care Unit at South Shore Hospital. Six tiny, swaddled preemies are ready to be examined, their eyes numbed and their pupils dilated with special drops.

Gretchen Hamn, NNP, and medical assistant Margie Young go from isolette to isolette. Young tends to the first baby and gently positions him for his exam. Hamn pulls over a cart and extends a kind of hose with a camera at the tip. This she places directly on each of the baby’s eyes, taking a digital video of his retinas.

Read Full Story | 1 Comment | Leave a Comment

It’s not the stem cells but what’s inside them that matters for babies with lung disease

The molecular equivalent of a message in a bottle could open up the possibility of stem cell-based therapies for newborn lung disease — but without the cells. (aturkus/Flickr)

Three years ago, Stella Kourembanas, MD, and S. Alex Mitsialis, PhD, thought they had a major breakthrough in treating pulmonary hypertension (PH) — dangerously high blood pressure in the pulmonary artery (the vessel that carries blood from the heart to the lungs) — and bronchopulmonary dysplasia (BPD) — a chronic lung disease that can affect babies born prematurely or who were put on a ventilator.

The two diseases are complex and serious, often occur together and are currently incurable.

The solution for PH and BPD, the two researchers from Boston Children’s Division of Newborn Medicine thought, was to protect the babies’ fragile lungs with a kind of stem cell called mesenchymal stem cells (MCSs), which can develop into lung tissue.

Their preclinical studies were pretty conclusive. If they transplanted MSCs in mouse models of BPD and PH, the mice didn’t develop the lung inflammation that triggers the disease.

But the results were a little confusing.

Read Full Story | Leave a Comment

Modeling sepsis in newborns: toward better detection and treatment

Sepsis, a serious, hard-to-diagnose threat in the NICU, can interfere with a baby’s development even when cleared with antibiotics. (Image: Army Medicine/Flickr)

Sepsis, or bacterial infection of the bloodstream, is a grave threat to premature infants in the neonatal intensive care unit (NICU) who have catheters and intravenous lines. Even when antibiotics clear the infection itself, the inflammation that it causes can do just as much damage. Not only can sepsis and the resulting inflammation interfere with fragile preemies’ ability to gain weight, but a growing literature suggests that they can impair brain development.

Preventive measures can now avoid many cases of sepsis, but those that slip through can be hard to detect in newborns.

“Newborns can’t speak, and they have unique immune systems, so they tend not to have fevers or show clinical signs,” explains Ofer Levy, MD, PhD, of the Division of Infectious Diseases at Boston Children’s Hospital. “There may be irregular breathing or increased heart rate, or the baby may be acting a little ‘off,’ but these signs are pretty nonspecific. There’s a tremendous need for better diagnostics in this field.”

Levy and colleagues recently described a mouse model that, for the first time, captures the effects of sepsis on the newborn immune system. They and others have begun using it to identify diagnostic markers and better treatments.

Read Full Story | Leave a Comment

Can you see what I see? Maybe not, but the computer can

What if you could just look at someone’s face and tell how fast his or her heart is beating?

The question isn’t as far-fetched as you might think. The movement of our beating heart inside our chest can in fact reveal itself on the surface of the skin, albeit too faintly for our eyes to see. But as you can see in this video, it’s not too faint for a computer (fast forward to 1:25 and 3:18):

Donna Brezinski, MD, of Boston Children’s Hospital’s Division of Newborn Medicine and Neonatal Intensive Care Unit (NICU), recently described the system used to make that video at one of the hospital’s Innovators’ Forums (a series of monthly talks hosted by Boston Children’s Innovation Acceleration Program). It uses computer-based video processing to make a pulse look like it’s bulging on a person’s wrist, or to amplify changes in skin color as freshly oxygenated blood gets pumped through the body.

Read Full Story | Leave a Comment

Let the line shine through: Lighting the way for complicated IV lines

A fiber optic tube like this could help make it much easier for doctors to place PICC lines and other catheters deep within the body.

The idea first came to Farhad Imam, MD, PhD, eight years ago as a trainee after a 30-hour shift.

Imam was helping care for a baby with particularly complex needs and who needed to have several IV lines inserted. The baby started having complications related to one of those lines, a deeply threaded one called a peripherally inserted central catheter, or PICC line, which had gone astray and had to be repositioned.

Walking out of the hospital at his shift’s end, Imam found himself wishing there were an easy way to visualize, in real time, the progress of lines that advance deep into the body through a child’s veins.

If only we could make these lines light up, he thought to himself….

Read Full Story | Leave a Comment

Preventing autism after infant seizures

Early seizures may disrupt circuit formation in babies' brains, leading to autism. But new research suggests that an existing drug can reverse this.

This is the third post in a series about new approaches for seizures and epilepsy. Read the first and second posts.

We already know that there’s some kind of connection between epilepsy and autism: Children who have seizures as newborns not uncommonly develop autism, and studies indicate that about 40 percent of patients with autism also have epilepsy. New research at Boston Children’s Hospital finds a reason for the link, and suggests a way to break it — using an existing drug that’s already been given safely to children.

In the online journal PLoS ONE, Frances Jensen, MD, in the Department of Neurology and the F.M. Kirby Neurobiology Center at Boston Children’s, and lab members Delia Talos, PhD, Hongyu Sun, MD, PhD, and Xiangping Zhou, MD, PhD, showed in a rat model that early-life seizures not only lead to epilepsy later in life, but also produce autistic-like behaviors.

Drilling deeper, they showed that early seizures hyper-activate a group of signaling molecules collectively known as the mTOR pathway.

Read Full Story | 1 Comment | Leave a Comment

Glimpsing a baby’s brain: Advanced neuroimaging

Surprisingly little is known about the brains of babies under age 2 — because of the challenges of safely imaging children so young. Head-circumference measures at the pediatrician’s office tell very little about what’s going on inside. But there’s much to know, because rapidly developing brains are vulnerable to injury.

Here, Ellen Grant, a neuroradiologist trained in theoretical physics, describes how advanced imaging techniques and computational science are providing a better understanding of the newborn and even fetal brain. With these tools, neurologists can watch the brain as it forms and folds, track the growth of individual brain structures, and detect problems in brain organization before anything can be noticed by parents or physicians — then correlate these measurements with child developmental measures.

Children’s Hospital Boston is building a neuroimaging facility with specially designed, baby-sized equipment — the only one in the world to be situated near a neonatal and pediatric intensive care unit. It will help answer questions like: What prenatal brain development is missed when a baby is born even two weeks shy of its due date? What does a brain structure growing out of synch at 6 months mean for language development in preschool? Are interventions for brain injury, such as hypothermia, effective? Grant’s ultimate goal is to get advanced neuroimaging into routine clinical care, to monitor infants and newborns with brain injury, predict their future course, and evaluate new treatments.

Read Full Story | Leave a Comment

Frances Jensen at TEDMED: “No more hand-me-down drugs”

Image by Steve Case via TwitPic: http://twitpic.com/31dosf

Before Children’s Hospital Boston’s own Frances Jensen, Director of Epilepsy Research, took the stage yesterday, Richard Saul Wurman, organizer of TEDMED and the TED conferences, spoke warmly of Children’s participation and sponsorship of this year’s event. A generous gift from the Hassenfeld Family Initiatives enabled that participation, and Wurman thanked the Hassenfelds and Children’s for bringing “such interesting people” to TEDMED 2010. With that, Jensen began her talk about the importance of understanding the developing brain.

Read Full Story | Leave a Comment

A distant star: a single vaccine at birth

Ofer Levy is nothing if not passionate. Talking about his new project, he starts taking notes on my pad for me, to make sure I catch every detail. When Levy was getting his MD/PhD at NYU, one of his mentors told him, “In pursuing your life’s passion as a researcher, you should set your sights on a distant star.”

Read Full Story | Leave a Comment