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.

Agency
National Institute of Health (NIH)
Institute
National Institute of Neurological Disorders and Stroke (NINDS)
Type
Exploratory/Developmental Grants (R21)
Project #
5R21NS040374-03
Application #
6639672
Study Section
National Institute of Neurological Disorders and Stroke Initial Review Group (NSD)
Program Officer
Chen, Daofen
Project Start
2001-04-20
Project End
2005-03-31
Budget Start
2003-04-01
Budget End
2005-03-31
Support Year
3
Fiscal Year
2003
Total Cost
$196,250
Indirect Cost
Name
Stanford University
Department
Pediatrics
Type
Schools of Medicine
DUNS #
009214214
City
Stanford
State
CA
Country
United States
Zip Code
94305
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Rose, Jessica; Mirmiran, Majid; Butler, Erin E et al. (2007) Neonatal microstructural development of the internal capsule on diffusion tensor imaging correlates with severity of gait and motor deficits. Dev Med Child Neurol 49:745-50
Constantinou, Janet C; Adamson-Macedo, Elvidina N; Mirmiran, Majid et al. (2005) Neurobehavioral assessment predicts differential outcome between VLBW and ELBW preterm infants. J Perinatol 25:788-93
Mirmiran, Majid; Barnes, Patrick D; Keller, Kathy et al. (2004) Neonatal brain magnetic resonance imaging before discharge is better than serial cranial ultrasound in predicting cerebral palsy in very low birth weight preterm infants. Pediatrics 114:992-8
Arzoumanian, Y; Mirmiran, M; Barnes, P D et al. (2003) Diffusion tensor brain imaging findings at term-equivalent age may predict neurologic abnormalities in low birth weight preterm infants. AJNR Am J Neuroradiol 24:1646-53