The Jooay App: Promoting Participation in Leisure
This newsletter presents the Jooay app, a free app that connects children with disabilities and their families to leisure opportunities.
The birth of a newborn is a joyful and exciting time. However, sometimes, a baby is born with complications that require special medical care. Newborns may have difficulties associated with pregnancy complications, fetal development or related to labour and birth. Some of these newborns are at high-risk for developmental problems as they grow older.Fortunately, specialized care and advances in medical technology can help improve the health of a high-risk newborn and new mother. Babies have a much greater chance of surviving and having favourable outcomes than ever before.
Overview For Parents
- Medical advances have allowed more newborns to survive into adulthood than ever before.
- Brain development accelerates rapidly during the third trimester of gestation. Infants born early are vulnerable to altered brain development or brain injury.
- Brain injury is most common among extremely premature infants who are born before 27 – 28 weeks of gestation, when the third trimester begins.
- Newborn babies born at term may also be at high-risk for developmental problems if their brain didn’t develop optimally during pregnancy, or if the baby was exposed to a brain injury.
- Current advances in brain imaging with MRI are making it easier to recognize brain abnormalities so that newborns and children can be targeted for appropriate supportive and protective treatment and early therapeutic interventions to maximize their developmental outcomes.
Overview For Clinicians
- Early identification of at-risk newborns is important because it allows for intervention while the central nervous system is still forming new connections and reorganizing itself.
- Early treatment is more effective in influencing long-term outcome than treatment that begins after the first presentation of neurodevelopmental disability, which is often around two years of age or even later.
- Imaging studies should carefully examine the basal ganglia and cerebellum in addition to cortical and subcortical structures, as areas that are vulnerable to brain injury.
Newsletters
COACHING in Childhood Disability
Coaching interventions provide education and guidance to individuals. This newsletter describes different types of coaching for children with disability and their families, approaches that are commonly used, and the level of evidence for coaching.
Prematurity: Impacts for children and families
Most parents expect a normal term birth and the NICU experience alters expectations and can be an emotional roller coaster. This newsletter provides an overview of challenges and advances in research to improve outcomes for premature babies.
Articles
How well does fetal MRI diagnose inferior vermian hypoplasia?
This study examines the accuracy of fetal MRI in the diagnosis of isolated inferior vermian hypoplasia and describes the developmental outcomes after birth.
What are some advances in the identification of disorders in cerebellar growth and development?
This review summarizes our current understanding of the development of two important structures in the brain: the cerebellum and the brainstem
How can we study the effects of infection in the immature brain using animal models?
The authors developed an original rat model of neonatal brain lesions that replicate the combination of infectious insults which are detrimental to the brain during the newborn period in humans.
Doctors should carefully distinguish between Hemophagocytic lymphohistiocytosis (HLH) and enteroviral infection to treat each appropriately
Though they have very different prognoses and treatment protocols, it is difficult to distinguish between enteroviral infection and hemophagocytic lymphohistiocytosis (HLH). Treatment for HLH has high risks, especially in newborns, so doctors should exercise extreme caution when making the diagnosis for HLH and deciding to carry out its treatment.
Anticoagulant therapy relatively safe for children with Arterial Ischemic Stroke (AIS)
Arterial ischemic stroke (AIS) occurs when the blood flow to the brain is blocked. Anticoagulant therapy (ACT), which helps prevent blood clots, is often used to treat adults with AIS to prevent recurrent strokes.
Does head size in children diagnosed with microcephaly predict developmental performance?
The purpose of this study was to find out if the head circumference measured at 2 years of age could predict the level of developmental performance in a group of children who are at high risk for developmental deficits.
Neurobehavior status describes the status of a person’s physical behaviors in relation to damage to parts of the brain.
The Neurobehavioral Assessment of Preterm Infants (NAPI) was developed to measure the neurobehavioral status in pre-term infants born at least 8 weeks premature. This instrument has many unique advantages, however, it is not known if it is valid compared to other established tests.
Is growth of the cerebellum affected by premature birth?
This study describes cerebellar growth in preterm infants from 28-40 weeks postconceptional age.
Stroke patterns in neonatal group B streptococcal (GBS) meningitis
Meningitis is a disease caused by either bacteria or viruses that causes inflammation of thin tissues that cover the brain and spinal cord. In this study, researchers hope that prevention strategies can be designed to lessen the damage caused by GBS meningitis.
Is the neurobehavioral assessment of preterm infants a valid measure of neurobehavioral status?
The main aim of this study was to find out if the clinical measure called the Neurobehavioral
Assessment of Preterm Infants is measuring the attributes of preterm infants that it claims to be
measuring (i.e. neurobehavioral status).
What is the relationship between general brain injuries and the cerebellum in premature infants?
The objective of this study was to determine whether general brain injury is associated with less growth of the cerebellum.
Are children who were born premature at risk for poor handwriting performance when compared to peers?
Children born premature are at risk for developmental delays and academic difficulties at school age. This study found that children born premature had significantly lower legibility and slower speed scores on most handwriting tasks when compared to peers.
Is cerebellar hemorrhage a common brain injury in preterm infants?
This study described the frequency of cerebellar hemorrhage in premature infants. Learn about the factors that increase the risk for cerebellar hemorrhage and the methods used to detect it.
Towards a better understanding of the detection, causes, and management of stroke in newborns and children
Pediatric stroke is rarely fatal but about half of those who survive will develop a long-term neurological deficit. Current advances in neuroimaging are making it easier to recognize stroke so that newborns and children can be targeted for appropriate supportive and neuroprotective treatment to minimize long-term damage.
Topiramate may be effective for treating seizures in newborns
Seizures in newborns may cause brain injury or they may be indicative of an underlying brain injury, and it is essential to treat injuries in addition to the seizures. For decades, neonatal seizures have been treated with phenobarbitol and phenytoin, even though these have limited success and may be harmful to the developing brain. Rigorous studies may show that topiramate is a safer and more effective treatment for seizures in newborns.
Readily available indicators may predict risk of adverse outcome in asphyxiated newborns who experience seizures
Depending on the extent of brain injury, one or more developmental disorders may emerge in newborns who experience seizures following birth. The indicators described in this study do not precisely predict which disorder will appear or how severely it will affect the child, but they do provide a good idea of whether or not the possibility for future developmental deficits exists.
One case of extreme prematurity suggests a possible link between cerebellar injury and autism spectrum disorders
This report of a survivor of extreme prematurity with cerebellar injury, who was diagnosed with autism spectrum disorder (ASD), adds to growing evidence of a link between this spectrum of disorders and prematurity associated cerebellar injury.
Changes in blood flow to the brain may help doctors predict brain injury in newborns with stroke
Arterial ischemic stroke (AIS) is caused by a blockage in an artery feeding the brain. Newborns who suffer a stroke may display seizures immediately, in which case they are easier to identify and support, or they may only display symptoms of the stroke in the long-term. Long-term effects of perinatal stroke may include seizures, motor impairment, developmental delay, and cognitive and behavioral problems. It is possible that brain perfusion levels can be used to detect and treat salvageable tissues, mitigating these long-term effects.
Injury to the cerebellum in premature infants can be accompanied by region-specific impairments to cerebral growth
Brain development accelerates rapidly during the third trimester of gestation, and infants born before this process are vulnerable to brain injury. This injury can affect neurodevelopment, impairing later motor, social, behavioral, cognitive, and language abilities. Improved early detection of brain injuries and a deeper understanding of their full extent will allow practitioners to develop valuable therapies for improving long-term outcomes among preterm infants.
Increased blood flow to the brain following asphyxiation may predict a newborn’s risk for brain injury
This study shows us that perfusion rate following asphyxiation does influence the extent of brain injury that leads to neurological deficits in high-risk newborns. Hypothermia is currently the only effective treatment for minimizing neurological deficits in high-risk newborns following asphyxiation. It is thought that hypothermia therapy prevents reperfusion injury by slowing the cascade of events that lead to cell death.
The important distinction between hemophagocytic lymphohistiocytosis and enteroviral infection
Enteroviral infection is the most frequently diagnosed viral infection among newborns and is treated according to its severity. Hemophagocytic lymphohistiocytosis (HLH) is a rare but fatal disorder of an exaggerated immune response, treated with chemotherapy or immunosuppressive agents. Because HLH is so rare, it should only be diagnosed with great care in newborn patients displaying enteroviral infection
A new scoring system can help doctors predict future neurological deficits in newborns who experience seizures
Medical advances have allowed more newborns experiencing seizures to survive into adulthood than ever before. Early identification of children likely to develop developmental disorders following neonatal seizures will allow for early treatment, which can minimize eventual cognitive and motor delays.
Communities
Canadian Neonatal Follow-Up Network
A network of healthcare professionals dedicated to improving the care of newborns and children at high risk of adverse outcome as a result of requiring intensive medical care.
Canadian Neonatal Network
A group of Canadian researchers who collaborate on research issues relating to neonatal care.
Canadian Premature Babies Foundation
An organization dedicated to raising awareness about preterm birth and providing a platform for Canada-wide education and research.