Stories about: prematurity

Personalized care model enhances preterm babies’ development

NICU baby with his mother
Christian, born at 26 weeks gestation, has lived in the NICU since May. (Photos: Katherine C. Cohen, unless otherwise noted)

November 17, 2017 is World Prematurity Day.

From a cozy, dark and quiet existence, a preterm baby is forced out into a harsh, bright and noisy environment. Instead of being comforted and held securely by their parents, preemies are poked and prodded, hooked up to machines and exposed to jarring sights and smells as their developing brains struggle to realign.

Each year, an estimated 15 million babies around the world — 1 in 10 — are born prematurely. Medical advances enable more of them to live, but often with medical and developmental problems.

Heidelise Als, PhD, director of Neurobehavioral Infant and Child Studies at Boston Children’s Hospital, has worked for more than 30 years to create better outcomes, developing the Newborn Individualized Developmental Care and Assessment Program, or NIDCAP.

The NIDCAP model of care seeks to support the development of fragile newborns and reduce their stress. In a series of studies, Als and colleagues at other hospitals have documented its successes: improvements in lung function, feeding and growth; shorter lengths of stay; a reduction in brain hemorrhage and improved brain function and structure, with brain effects lasting until at least 8 years of age. Benefits have been documented even in medically fragile, very preterm infants and infants with severe intrauterine growth restriction.

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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.

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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.

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