A Wake Forest School of Medicine researcher has identified brain malformations that appear to be part of a syndrome that could potentially be a leading cause of death in premature infants.
William R. Brown, Ph.D., director of the Brain Microvascular Pathology Laboratory at Wake Forest, discovered a new type of brain malformation, called cortical cleft malformation, which is associated with premature birth and early death. Brown presented his findings at the Pediatric Academic Societies Meeting in Seattle on May 3.
“The brain malformations may result from blood clots that circulate from the placenta to the developing brain,” Brown said. “This would cause cell death and a hole to form called a cortical cleft. This finding suggests an answer to the question, ‘Why did this baby die?’ to parents and physicians who look for underlying medical causes to explain the death of many preterm babies.”
The malformations were found using ultrasound and MRI scans during autopsies of premature infants that had died soon after birth. Brown and his team looked at brain tissues from 33 premature babies accumulated over a nine year period. Thirty-one had these brain malformations.
“Normally, you would not be able to find these malformations in a live patient using ultrasound,” Brown said. “They are too small. But after autopsy, our specialized staining procedures make these lesions easier to see. ”
While it is not yet known how to prevent these malformations, Brown and his team hope that by understanding how these lesions occur, strategies can be developed to prevent them and the subsequent preterm birth and early death.
“We suspect from our studies that the lesions originate early in pregnancy around the end of the first trimester or start of the second trimester,” he said. “Sometime after the damage to the brain has occurred, something causes the mother to go into premature labor. Babies with large malformations die within hours or days of birth. We don’t know why the mother goes into early labor or why the babies die, but it appears to be due to a syndrome involving these brain malformations. We are currently pursuing research funding to examine these questions.”
Babies may live with less severe forms of these malformations, but researchers suspect any survivors may suffer from conditions such as cerebral palsy and mental retardation, which often have no known cause.
“By answering some of these questions, we may be able to prevent premature births and brain dysfunctions such as cerebral palsy and mental retardation,” he said.
For neonatalogists, this breakthrough could mean the answers to questions that have been haunting physicians for years.
“This finding is very exciting for many reasons,” said Steve Block, M.D., a neonatalogist and director of the Neonatal Intensive Care Unit at Wake Forest. “It is so unusual to have a finding that is completely novel. If we start to look at causation, then we can begin to explore therapies that might prevent some devastating diseases. The ultimate goal is a healthy baby and more productive member of society.” ###
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