In the past three decades, the survival rate for premature babies has
increased significantly. But, extremely premature infants are prone to
neurological complications that doctors currently cannot prevent. Premature
infants develop cerebral palsy in 5-15 percent of cases and 25-50 percent
develop cognitive disorders or learning dysfunction.
Neonatologists, neurologists and radiologists at UCSF Children’s Hospital are
working to change these statistics. With the April 2008 opening of a new
Neuro-Intensive Care Nursery, this team inaugurated a program to improve
neurodevelopmental outcomes in very premature infants and in full-term babies
who are at high risk of neurological injury or have clinical evidence of
encephalopathy, seizures or stroke.
The program has been championed by Donna Ferriero, MD, chief of Pediatric
Neurology, and David Rowitch, MD, PhD, who is chief of Neonatology and a Howard
Hughes Medical Institute investigator. Dr. Rowitch was drawn from Harvard Medical
School to UCSF by the opportunity to work with internationally known UCSF
experts to provide this much-needed care.
“Birth-related neurological injury is
the leading cause of mental retardation and cerebral palsy in the United States. The UCSF Neuro-Intensive Care Nursery will offer a new standard of
care for patients and address concerns of families confronted with the
possibility of neurological injury in their newborn. Our goal is to create the
most comprehensive possible assessment and treatment program in the United
States.” David Rowitch, MD, PhD
Neuroimaging
Newborns in the nursery will also be routinely
evaluated with magnetic resonance imaging (MRI), using
techniques pioneered by A. James Barkovich, MD, chief of
Pediatric Neuroradiology. Working with a team that
included clinical nurse specialists, Barkovich developed
the first MRI-compatible incubator, which has allowed
this imaging study to be performed on extremely
premature babies who require a carefully controlled
environment. Magnetic resonance imaging studies will be
integrated with information from cerebral function
monitoring and magnetic resonance spectroscopy to
provide valuable insights into brain anatomy and
metabolic activity.
Neuromonitoring
Cerebral function monitoring (CFM) can provide a
window into the brain activity of newborns. Under the
direction of Yao Sun, MD, PhD, director of Neonatal
Clinical Programs at UCSF, the new nursery will
routinely use the same intensive monitoring that adult
stroke patients receive. It is provided through 8-12
lead electroencephalography (EEG) that can quickly
switch from a simplified (amplitude integrated) reading
to a full EEG. CFM is used in other nurseries, but
typically only when an infant may be having seizures,
according to Dr. Sun. In the Neuro-Intensive Care Nursery,
this monitoring will be a routine part of clinical care.
Dr. Sun, who has an extensive background in computer
science, will oversee the integration of the large
amount of data gathered on these babies into a
clinically useful form.
Neurotherapy
Under a clinical research protocol,
the nursery will be treating infants who have moderate
hypoxic encephalopathy with hypothermia – lowering the
baby’s temperature with a cooling cap or blanket. Research has shown that cooling the brain and
body by a few degrees immediately after birth can help
reduce neurological damage in babies who have sustained
certain types of brain injury
More info on Hypothermia Treatment
Dedicated Newborn Neurology
Dr. Ferriero, one of the foremost neonatal
neurologists in the United States, oversees a dedicated
team that assesses neurological function in critically
ill newborns. Working with her is neonatal neurologist
Hannah Glass, MD, who will coordinate the clinical
aspects of neurological care provided in the nursery.
The neurology team will also oversee the training of a
new cadre of specialists seeking to understand the role
of complications of early birth and intensive care in
the newborn brain injury.
Individualized Developmental Care
New staff member Kathleen VandenBerg, PhD, will
oversee implementation of a Newborn Individualized
Developmental Care and Assessment Program (NIDCAP)
training center at UCSF. In the NIDCAP model of care,
infants are carefully observed within the newborn ICU
setting to determine if their behaviors suggest that
they are under any stress of discomfort. This
information is then used to provide an environment that
is as comfortable as possible and developmentally
appropriate for each baby.
New Directions in Research
Efforts to advance diagnosis and treatment will be
coordinated by Drs. Rowitch and Ferriero, co-directors
of the UCSF Newborn Brain Research Institute (NBRI). As more is
learned about the structure and function of the newborn
brain, a “translational” approach will streamline the
development and testing of new neuroprotective
therapies. Researchers hope to quickly determine if a
therapy may be effective by analyzing data from imaging
studies, monitoring and clinical observation. “Our goal
is to offer patients and their families real therapeutic
options when faced with neurological injuries,” says
Dr. Rowitch.