A new study from UCSF that mapped neural connections in newborns with two different types of brain damage found that the maps looked very different and were linked to significantly different developmental outcomes years later.
The study, published today in PLOS ONE and led by researchers in pediatrics, neurology and radiology at UCSF, used diffusion MRI to visualize the cerebral wiring of two sets of newborns: one set with congenital heart defects (CHD) and the other with hypoxic-ischemic encephalopathy (HIE) – otherwise known as asphyxia at birth.
HIE babies suffer from brain damage and oxygen deprivation days to hours after birth, while CHD babies are regularly deprived of oxygen for longer – often months – in utero. Both groups are known to be at high risk for neurodevelopmental disorders as they age, in areas ranging from motor skills to attention to behavior problems.
“You have two groups of children who, before or during birth, have brain damage and end up having delayed or impaired development and problems by school age,” said Patrick McQuillen, MD, professor of pediatrics and of Neurology at UCSF, and the corresponding author of the study. “We wondered if the newborn’s brain, when faced with something difficult at different times, reacted in the same way. What we found was that the brains of these two groups of babies had l look very, very different. “
Brain differences linked to the results
The researchers found that the distinct differences in brain wiring between the groups correlated with later motor and language outcomes. Specifically, they found that newborns with coronary artery disease had poorer language function at 12 to 18 months and worse cognitive, language, and motor functions at 30 months than infants born with HIE, whose results in both times were within the normal range.
While about 20 percent of babies with coronary artery disease had scores below the normal language range between 12 and 18 months, the number dropped to 50 percent below normal at 30 months. In addition, 37% of children with coronary artery disease had lower than normal cognitive scores and 25% lower than normal motor scores at 30 months. The language delays appeared to be due to expressive and unresponsive language impairments, the study authors noted.
The main difference between CHD and HIE brains appearing on imaging was in an area called “overall efficiency,” which measures how easy it is to make a connection from one area of the brain to another. An efficient brain is like a traffic system with an ideal balance of freeways and local roads that get a driver where they need to go fast, McQuillen explained.
Researchers will continue to follow the babies in the study and recently received a grant from the Children’s Heart Foundation to perform additional brain imaging and testing on school-age subjects. They hope that by understanding how brain connections work and match developmental outcomes, researchers will be able to link children with brain damage more quickly to early intervention. Eventually, children may even have treatments tailored to their type of brain injury.
“We’re not there yet,” McQuillen said. “We’re still in the process of describing what’s different and using those models to make predictions about the outcome. But I’m hopeful that I know where it’s going.”
Other study authors include Shabnam Peyvandi, MD, MAS, and Stephany Cox, PhD, of the Department of Pediatrics at UCSF; Dawn Gano, MD, MAS, of the Departments of Pediatrics and Neurology at UCSF; Duan Xu, PhD, and Olga Tymofiyeva, PhD, from the Department of Radiology, UCSF. Alice Ramirez, MD, was a member of UCSF in intensive care at the time this research was conducted.
This study was funded by NIH grants P01NS082330 and K23NS099422.