Houston, Texas, USA : A 15-minute scan could help diagnose brain damage in babies up to two years earlier than current methods.
In a study of over 200 babies at seven hospitals across the UK and the USA, researchers found the brain scan, called magnetic resonance (MR) spectroscopy, predicted damage with 98 per cent accuracy.
Brain damage affects around one in 300 births in the UK, and is usually caused by oxygen deprivation. However, currently doctors are unable to accurately assess the extent of a newborn baby’s brain damage.
Any child suspected of having some type of damage is given an MRI scan shortly after birth. This allows doctors to look at black and white pictures of the brain see if any areas of the brain look lighter than others, as this may suggest damage. Doctors then use this information to give parents an estimation of the extent of the damage, and the possible long-term disabilities their child may face.
However, this method is only between 60-85 per cent accurate, and relies heavily on the radiologist’s individual judgement, meaning the prognosis can vary depending on who assesses the scan, and where the scan is done. Hence health professionals can only confirm if a child has lasting brain damage when they reach two years old, by assessing whether a youngster has reached their development goals such as walking and talking.
In the new study, led by Imperial College London, scientists used MR spectroscopy to assess the health of brain cells in an area called the thalamus, which coordinates a number of functions including movement, and is usually most damaged by oxygen deprivation.
The scan specifically tests for a compound called N-acetylaspartate—high levels of which are found in healthy brain cells, called neurons. A level of 9-10 is found in healthy neurons, whereas a level of 3-4 indicates damage.
The technology used is the same as that needed for an MRI scan, and only requires the baby to spend an additional 15 minutes in the scanner.
In the new trial, published in the journal Lancet Neurology, the scan was performed at the same time as the routine MRI scan when a baby was between four and 14 days old.
The scan does not carry any additional cost to the NHS, and the data can be easily analysed using special software by any radiographer.
Dr. Sudhin Thayyil, study author and Director of the Centre for Perinatal Neuroscience in Imperial’s Department of Medicine said: “At the moment parents have an incredibly anxious two-year wait before they can be reliably informed if their child has any long-lasting brain damage. But our trial—the largest of its kind—suggests this additional test, which will require just 15 minutes extra in an MRI scan, could give parents an answer when their child is just a couple of weeks old. This will help them plan for the future, and get the care and resources in place to support their child’s long term development.”
In the trial, funded by the National Institute for Health Research and the Medical Research Council, all of the babies had received so-called cooling therapy immediately after birth. This is now a routine treatment for newborns with suspected brain damage, and involves placing a baby on a special mat that reduces their body temperature by four degrees. Evidence has shown that cooling the body can help reduce the extent of brain damage, and reduce the risk of long term disabilities.
The babies then had their brain scan soon after this therapy, and detailed developmental assessment at two years of age. The results suggested the MR spectroscopy at two weeks accurately predicted the level of toddler’s development at two years old.
Dr. Thayyil added that the scan may also help scientists develop new treatments to tackle brain injury in babies: “At the moment, when doctors are trialling a new therapy that may boost development of children with brain damage, they must wait two years until they can assess whether the treatment is working. They also need to study a large number of babies. But with this new scan, they’ll be able to assess this almost immediately, with a much smaller number of infants.”
He added that the next step is to roll out the scan in more hospitals in the UK as a clinical tool. “Most NHS hospitals already have the facilities and software to perform this scan, it’s just a case of increasing awareness and training.”
“I remember the terror when we didn’t hear a cry”—Christine’s story
Christine Reklaitis gave birth to her daughter Georgiana in 2016, and took part in the trial at Imperial College Healthcare NHS Trust in London.
She said: “I had a healthy pregnancy, but during labour my midwife struggled to find Georgiana’s heartbeat, and she was born shortly afterwards via emergency c-section.
I remember the terror when we didn’t hear a cry after she was born, but thankfully she was breathing, and was whisked away to intensive care, and placed in an incubator. The doctors told us
they were going to cool her down, which we thought sounded unusual, but were told it would reduce her risk of brain damage.
We were asked to take part in a trial and quickly agreed. We felt our daughter’s treatment benefitted from past studies, so we wanted to help develop future treatments.
After the first scan we were told the levels of a compound in her brain cells were low, but were incredibly relieved when a scan a few weeks later showed the levels had increased to normal levels.
She has since hit all her development goals, and is a normal two-year-old, and full of energy. We joke the cooling treatment stayed with her, as she never wants to wear a coat when we go outside.
We are so pleased we took part in this trial—and hope the research helps other families.”
Infant Brain Damage
Infant brain damage is a serious condition that affects millions of babies each year. Although there are a myriad of causes, the end result usually means that the baby may experience long-term, permanent neurological problems and a wide range of physical problems. To better understand infant brain damage, it’s important to educate yourself on how these types of infant brain injuries occur, the symptoms to look out for, how they are diagnosed, and ultimately, which best treatment methods may be employed.
Infant Brain Damage Causes
Infant brain damage can be caused by a variety of ways, including oxygen deprivation, infant jaundice, physical trauma suffered during labor and delivery, and infections in the mother’s body. The resulting damage to the baby’s brain ranges widely in severity and can lead to various disabilities and psychological issues.
Oxygen Deprivation (Birth Asphyxia)
Oxygen deprivation, also known as birth asphyxia, occurs in about four of every 1,000 nine-month term births. Premature babies are a higher risk of being injured by oxygen deprivation. Shortly after delivery, infants begin to breathe on their own. If they are deprived of oxygen, there is only a small window of time that physicians have in order to treat the problem. Even a few minutes of oxygen deprivation can lead to lifelong brain damage and disorders such as cerebral palsy, autism, attention deficit hyperactivity disorder, impaired vision.
There are several reasons in which infants can be deprived of oxygen, including umbilical cord problems, problems with the mother’s blood pressure, constricted airways, the baby has anemia at birth, the placenta separating too early from the uterus, and getting stuck in the birth canal during delivery. However, these problems may be prevented if the healthcare provider is diligent in monitoring and treating fetal distress in a timely manner.
According to the Seattle Children’s Hospital, two stages of injury can occur in cases of oxygen deprivation, the first stage involves brain cell damage that occurs within the first few minutes due to lack of blood flow and oxygen. The second stage, reperfusion injury, occurs after the flow of blood and oxygen is restored. Reperfusion injuries may last for periods that range between a few days and several weeks.
Infants with mild or moderate oxygen deprivation often have complete recoveries, especially if they receive prompt medical assistance and physical therapy. Babies whose brain cells were deprived of oxygen for a longer period are more likely to suffer permanent damage to their brain, cardiovascular system, respiratory system, digestive organs, kidneys, and more.
In extreme cases, oxygen deprivation can lead to complete organ failure and death.
Infant jaundice is a common condition, especially in premature babies. It is a yellowish staining of a baby’s skin and eyes. Jaundice is caused by an excessive amount of bilirubin, a yellow pigment in red blood cells, in the baby’s blood.
If infant jaundice is treated immediately, there usually isn’t a reason for concern. However, if left untreated, bilirubin levels in the baby’s circulatory system increase. These higher levels of bilirubin cause a condition called kernicterus. Kernicterus is a form of brain damage marked by lethargy, high-pitched screaming, a high fever, and abnormal arching of the back.
Bilirubin is toxic to the delicate cells in the brain. In addition to kernicterus, high levels of bilirubin in a baby’s brain can cause a more serious condition called acute bilirubin encephalopathy. Acute bilirubin encephalopathy is triggered by severe cases of untreated infant jaundice
According to the Mayo Clinic, symptoms of acute bilirubin encephalopathy include:
Impaired ability to suck or feed
Backward arching of the neck and body
According to the University of California, San Francisco (UCSF) School of Medicine, birth related brain injuries are the leading cause of cerebral palsy and intellectual disabilities in the United States. Babies are most at risk of suffering brain injuries during the birth process, especially if they are premature.
During labor and delivery, a host of medical mistakes and other forms of physical harm may lead to infant brain damage. For instance, if a doctor doesn’t use birth-assisting tools properly, it may lead to brain damage due to improper placement and use of the tools, such as forceps or vacuums, on the infant’s head. Physical trauma can also occur if the delivery is performed too quickly and rapidly.
Other examples of physical trauma include a protracted, difficult delivery which may lead to head and brain trauma as the baby’s head is constantly hitting against the mother’s pelvic bone, and if the attending doctor does excessive twisting and pulling during a difficult labor.
Infections in the Mother
It’s important for physicians to monitor and detect maternal infections as soon as possible during pregnancy. If left untreated, infections such as rubella, herpes, varicella, and syphilis may lead to neonatal brain damage. Additionally, maternal preeclampsia has been associated with the risk of infant brain damage.
Other types of maternal infections include:
Vaginal yeast infections
Coughs that last more than one week
Per a Danish clinical study, babies of women with maternal infections may also be at higher risk of developing childhood epilepsy, cognitive issues, and schizophrenia.
Maternal infections may also lead to premature birth, which in turn heightens the risk of infant brain damage and cerebral palsy. In fact, close to 25% of all premature births in the United States have been associated with maternal infections. Premature infants with low birth weights have an increased risk of developing brain damage and various other disabilities and physical limitations.
Symptoms of Infant Brain Damage
The types of symptoms as well as the severity will vary according to how the brain damage occurred. Some of the symptoms will be immediately noticeable while others may not surface until the infant shows signs of developmental delays.
Common symptoms include:
Abnormal Temperament: Although is normal and expected that infants cry after birth, excessive crying and high-pitched wails, combined with other abnormal behavior such as refusing nourishment and being extremely fussy may be a sign of brain damage.
Physical Appearance: Although there are instances in which an infant with brain damage looks physically fine, in many instance an abnormal physical appearance is a sign of brain damage. For example, infants with brain damage may have unusually small skulls, have difficulty focusing their eyes, deformed facial features, a deformed spinal cord, and an abnormally large forehead.
Delays in Development: As mentioned earlier, sometimes brain damage isn’t detected until an infant is slow in developmental delays. For instance, some babies may not crawl, smile, or crawl appropriately for their age. However, it’s important to keep in mind that all babies do not hit developmental milestones at the same time. Only a physician will be able ascertain if your infant’s developmental delays are a result of brain damage.
Infant Brain Damage Treatment Options
Treatment will depend upon the seriousness of the injury. For instance, an infant who experiences mild brain damage may not benefit from surgery, but physical therapy, occupational therapy, and medication may be be the best option. Yet, infants who experience traumatic brain injuries may need surgery to decrease swelling and intracranial pressure, and repair damaged blood vessels.
A relatively new treatment option for infant brain damage, hypothermia therapy, has shown positive results if administered immediately after birth. Hypothermia therapy works by cooling the infant’s body temperature to between 33.5°C and 34.5°C for at least three days immediately after birth.
According to the National Institutes of Health (NIH), hypothermia therapy not only increases an infant’s chance of survival, but also the decreases the chances of long-term, permanent brain damage and physical impairment.
Infant Brain Damage Prognosis
If attending physicians identify the damage-causing injury and start treatment immediately, infants may survive the traumas of brain, but more than likely will have to deal with a host of psychological, physical, and cognitive issues as they grow older.
For instance, according to the Simon’s Foundation Autism Research Initiative (SFARI), infants who experience brain injuries are at high risk for developing autism. Attention deficit disorders, emotional outbursts, and physical disabilities have also been associated with brain damage. However, children with these health issues can go on to live productive lives if they are active in physical and occupational therapy.
It’s important to note that the prognosis of brain damage will worsen with more severe injuries. It also depends on what area of the brain the damage occurred. For example, an infant with subdural hematoma is at high risk for mortality, especially if treatment doesn’t start immediately. Yet, an infant who suffered mild brain damage may have slight disabilities but can otherwise lead a normal life.