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MR Spectroscopy Displays Differences in Brains of Preterm Infants

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Based on a new study set to be presented at the annual meeting of the Radiological Society of North America (RSNA), premature births seem to trigger developmental processes in the white matter of the brain that could potentially put children at higher risk of problems later in life.

Preterm infants, usually those born 23 to 36 weeks follwoing conception, compared to the standard 37- to 42-week gestation, are faced with an increased risk of behavioral problems, ranging from impulsiveness and distractibility to more serious conditions like autism and attention deficit hyperactivity disorder (ADHD).

"In the United States, we have approximately 500,000 preterm births a year. About 60,000 of these babies are at high risk for significant long-term problems, which means that this is a significant problem with enormous costs,” said director of the New Imaging Technology Lab at Children's Hospital Los Angeles and associate professor of research radiology at the University of Southern California in Los Angeles, Stefan Blüml, Ph.D.

Blüml and peers have been examning preterm infants in a concerted effort to learn how premature birth could offset changes in brain structure that could be linked to clinical problems that arise later in life.

Most of the styudy’s focus has been on the brain's white matter, which broadcasts signals and allows communication between different regions of the brain. While some white matter damage is readily apparent on structural magnetic resonance imaging (MRI), Blüml's team has been using magnetic resonance spectroscopy (MRS) to observe differences on a microscopic level.

For this study, the researchers compared the concentrations of specific chemicals connected to mature white matter and gray matter in 51 full-term and 30 preterm infants. The study group had normal structural MRI findings, but MRS results revealed major differences in the biochemical maturation of white matter between the term and preterm infants, pointing to a disturbance in the timing and synchronization of white and gray matter maturation. Gray matter is the part of the brain that processes and sends out signals.

"The road map of brain development is disturbed in these premature kids. White matter development had an early start and was 'out of sync' with gray matter development,” said Blüml.

According to Blüml, this false start of white matter development is spurred by events at birth.

"This timeline of events might be disturbed in premature kids because there are significant physiological switches at birth, as well as stimulatory events, that happen irrespective of gestational maturity of the newborn. The most apparent change is the amount of oxygen that is carried by the blood,” he said.

“The amount of oxygen delivered to the fetus's developing brain in utero is quite low, and our brains have evolved to optimize development in that low oxygen environment. However, when infants are born, they are quickly exposed to a much more oxygen-rich environment. This change may be something premature brains are not ready for,” he added.

While this change may lead to irregularities in white matter development, Blüml cited that the newborn brain has an incredible ability to adapt or even "re-wire" itself, a notion known as plasticity. Plasticity not only eanbels the brain to govern and acquire new skills over the course of development, like learning to walk and read, but could also make the brains of preterm infants and young children more responsive to therapeutic interventions, particularly if any abnormalities are identified early.

"Our research points to the need to better understand the impact of prematurity on the timing of critical maturational processes and to develop therapies aimed at regulating brain development," said Blüml.

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