There have been significant advances in medical technology and care for critically ill neonates over the last 3 decades. Survival of very low birth weight infants (VLBW), at a significant national health cost and family hardship, is now a reality. Furthermore, the number of VLBW preterm infants has begun to increase due to advances in the science of fertility and increasing maternal age. The long term neurological morbidity for these lowest weight and gestational age infants is increased. The incidence of handicap in this population has changed little over the past decades. VLBW preterm infants constitute 25% of all children with cerebral palsy (CP). Currently, we lack diagnostic techniques to identify brain injury such as CP early (i.e., around corrected term age). Although the brain injury is present from early neonatal period, it takes 1-2 years before the disease is neurologically manifested. Thus, our ability to learn more about causes, prevention, and treatment is currently very limited. This proposal utilizes state-of-the-art MRI technology to predict those preterm infants who will develop CP. This innovative proposal concerns a timely pediatric problem of critical importance to pediatricians, neonatologists, pediatric neurologists, radiologists and MR physicists. Using quantitative MRI, EEG, and neurobehavioral tests we hope to be able to identify infants at risk for CP as early as 37 weeks post conceptional age. The collaboration between neonatal, neurological, and neuroimaging expertise is integral for an advance in our knowledge of detecting neonatal neurobiological pathology prior to 1-2 years of age. It is essential to discover a new approach to identify brain injury early, before it will be possible to effectively investigate interventions that can improve neurological outcome of these high risk very premature infants.
