STANFORD, Calif. - Kids on a playground can be hard to tell apart. But those who were born significantly preterm may be struggling with a hidden handicap that sets them apart from their peers: specific areas of the brain that are smaller than normal, even years later.
A collaborative study between the Stanford, Yale and Brown medical schools compared the brain volumes of two types of 8 year olds: those born prematurely and those born full-term. The researchers found significant, lingering reductions in the areas of the cerebral cortex responsible for reading, language, emotion and behavior. Even more surprising, the researchers discovered that the brains of preterm boys were more severely affected than were girls.
"It's fascinating," said Allan Reiss, MD, the Howard C. Robbins Professor of Psychiatry and Behavioral Sciences at Stanford. "It's as though we're seeing echoes of the 'big bang' of preterm birth at 8 years of age." Reiss is the director of the Stanford Psychiatry Neuroimaging Laboratory and co-director of the Center for Brain and Behavior at Lucile Packard Children's Hospital.
Doctors have known that preterm newborn boys fare more poorly than girls, but it's not been clear why. The differences persist even after the early medical hurdles have been cleared: preterm boys struggle more than preterm girls with speech and language and have a harder time in academic and social situations as they grow older. Although it stands to reason that newborns making an unreasonably early appearance have smaller brain volumes than full-term babies, it wasn't known that boys' brains are more severely affected or that the disparity persists for so long.
"This is a remarkable finding," said Reiss. "Smaller brain volume has never been specifically related to increased risk of adverse outcome in males as opposed to females. This is a striking and significant developmental abnormality in males who were born preterm."
Reiss and Stanford co-investigator Shelli Kesler, PhD, collaborated with Laura Ment, MD, Betty Vohr, MD, and colleagues at Yale and Brown to compare brain-imaging data of 65 preterm children to 31 healthy, full-term children. Preterm babies were born at around 28 weeks of gestation and weighed about 2 pounds at birth. The study is published in the August issue of the Journal of Pediatrics.
"In the preterm group as a whole, we found the volumes of both grey matter and white matter were reduced," said Reiss. "When we divided the preterm group by gender we found, bingo, the females had normal or preserved white matter volume, but the males' volumes were reduced compared to their full-term peers."
White matter is primarily made up of the axon connections and cells that facilitate communication between parts of the brain over distances, whereas grey matter consists of the cell bodies of the brain's nerve cells, where signal processing and thinking happen. White matter lesions are responsible for the symptoms of multiple sclerosis, which compromise both mobility and cognitive functions.
"The adverse effects of preterm birth, such as hypoxia, expose the premature brain to an environment it's not yet supposed to be in," said Reiss. "Researchers have hypothesized that white matter might be preferentially affected, but sex-based differences have never been clearly shown until now." Reiss speculates that girls may gain a measure of protection either through genetics or hormones.
"Girls have a real genetic advantage," he said. "Unlike boys, they have two X chromosomes, giving them a layer of partial genetic redundancy that may help protect against the effects of preterm birth. It's also very possible that differences in hormone levels between boys and girls before and after birth may play a role."
The researchers also looked at which specific white matter areas are most compromised by preterm birth. "We found that certain parts of the brain were more vulnerable to the effects of preterm birth than others," Reiss said. "In males, the temporal lobe and the deep cerebral region of the brain are preferentially affected. This is very interesting, because it turns out that individuals who are born preterm often have particular problems in language-based areas, and the temporal lobe is one of the seats of language." These areas are also involved in many other important functions, including emotion, attention and reading - classic Achilles heels for many kids born preterm.
"My hope is that our work may eventually contribute to the development of a brain equivalent of surfactant for the preterm lung," said Reiss, referring to a medical advance that has saved the lives of many preterm infants by helping their lungs prepare for a lifetime of breathing. "When it seems likely that a baby will be born prematurely, we give the mother steroids and the infant surfactant to compensate for the fact that the baby's pulmonary system is not fully developed. We're talking about a similar concept here where we have a brain not ready to stave off the effects of preterm birth. This research indicates that we should try to figure out a way to stimulate white matter growth in the brain of a preterm baby or develop a partially protective agent."
Stanford University Medical Center integrates research, medical education and patient care at its three institutions - Stanford University School of Medicine, Stanford Hospital & Clinics and Lucile Packard Children's Hospital at Stanford. For more information, please visit the Web site of the medical center's Office of Communication & Public Affairs at http://mednews.stanford.edu.
Lucile Packard Children's Hospital at Stanford is a 264-bed hospital devoted to the care of children and expectant mothers. Providing pediatric and obstetric medical and surgical services and associated with Stanford School of Medicine, LPCH offers patients locally, regionally and nationally the full range of health care programs and services - from preventive and routine care to the diagnosis and treatment of serious illness and injury. To learn more about Lucile Packard Children's Hospital, please visit our Web site at http://www.lpch.org.
Materials provided by Stanford University Medical Center. Note: Content may be edited for style and length.
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