Tag Archive for: McCarter

ambulance

Racial disparities in pediatric deaths related to police intervention

ambulance

Black and Hispanic adolescents are significantly more likely to die from shootings related to police intervention compared to non-Hispanic white adolescents, a recent study shows.

A recent study evaluating the use of force by police against children found that Black and Hispanic adolescents are significantly more likely to die from shootings related to police intervention compared to non-Hispanic white adolescents. The findings, led by Children’s National Hospital researchers and reported online Nov. 24 in Pediatrics, mirror similar racial and ethnic disparities in adults and highlight the need for interventions and policies to mitigate these tragedies.

In recent years, concerns about police use of force — particularly its disproportionate application to people of color — have grown exponentially in the U.S. Between 2003 and 2018, there were 6,512 firearm deaths from police intervention in adults, with non-Hispanic Blacks and Hispanics having significantly higher per population mortality rates than whites. However, it’s been unclear whether similar racial and ethnic disparities exist for adolescents killed by police intervention.

To explore this question, Monika K. Goyal, M.D., M.S.C.E., associate division chief of Emergency Medicine and Trauma Services and director of Academic Affairs and Research at Children’s National, and her colleagues used data from the Centers for Disease Control and Prevention’s Web-Based Injury Statistics Query and Reporting System. This database collects national data from death certificates compiled by the National Center for Health Statistics, including cause of death and race and ethnicity.

The researchers identified all adolescents between the ages of 12 and 17 years of age who died from firearm injuries due to police intervention between 2003 and 2018 within this database. They then compared rates of these deaths across different racial and ethnic populations based on U.S. Census Bureau data.

Dr. Goyal and her colleagues found that during the 16-year study period, 140 adolescents had died from police intervention, and of those, 113 involved firearms. The vast majority — about 93% — were male, with a mean age of about 16 years.

Using census data, the researchers found that the rate of firearm deaths due to police intervention was markedly higher among non-Hispanic Black and Hispanic youth when compared to non-Hispanic white youth. Numbers show that, compared to non-Hispanic white children, non-Hispanic Black children had a six-fold higher risk of death due to legal intervention. Similarly, Hispanic children had a risk of death almost three times higher.

“As the country works to reform policing practices and strives to mitigate disparities in our justice system, it is essential we do not forget the disproportionate impact on children of color,” Dr. Goyal says. “Our study confirms these disparities that are stark and unacceptable.”

Dr. Goyal adds that the study only collected data on adolescents who died, rather than non-fatal shootings, and thus, may underestimate the true toll of disparities in use of firearms against youth due to police intervention. Although the study was not designed to investigate the causes of these disparities, she says, recent events provide evidence of structural racism and bias among law enforcement personnel and in its policies.

Although these numbers are small, Dr. Goyal notes that there’s a potential rippling effect, with the death of each child having wide-ranging impact on an entire community.

“Any death of a child is devastating but when it is due to police violence, it leads to distrust in the system and undermines the primary mission to protect,” she says. “The pattern of stark racial and ethnic disparities only adds to this tragedy, further oppressing and alienating communities of color. It’s important to investigate, identify and correct those policies and personnel that perpetuate and exacerbate these disparities.”

Other researchers who contributed to this study include Gia M. Badolato, M.P.H., Meleah D. Boyle, M.P.H., and Robert McCarter, Sc.D., all of Children’s National; April M. Zeoli of Michigan State University; and William Terrill of Arizona State University.

 

coronavirus

Higher COVID-19 rates seen in minority socioeconomically disadvantaged children

coronavirus

Minority and socioeconomically disadvantaged children have significantly higher rates of COVID-19 infection, a new study led by Children’s National Hospital researchers shows.

Minority and socioeconomically disadvantaged children have significantly higher rates of COVID-19 infection, a new study led by Children’s National Hospital researchers shows. These findings, reported online August 5 in Pediatrics, parallel similar health disparities for the novel coronavirus that have been found in adults, the authors state.

COVID-19, an infection caused by the novel coronavirus SARS-CoV-2 that emerged in late 2019, has infected more than 4.5 million Americans, including tens of thousands of children. Early in the pandemic, studies highlighted significant disparities in the rates of infection in the U.S., with minorities and socioeconomically disadvantaged adults bearing much higher burdens of infection. However, says Monika Goyal, M.D., M.S.C.E, a pediatric emergency medicine specialist and associate division chief in the Division of Emergency Medicine at Children’s National whose research focuses on health disparities, it’s been unclear whether these disproportionate rates of infection also extend to youth.

To investigate this question, she and her colleagues looked to data collected between March 21, 2020, and April 28, 2020, from a drive-through/walk-up COVID-19 testing site affiliated with Children’s National — one of the first exclusively pediatric testing sites for the virus in the U.S. To access this free testing site, funded by philanthropic support, patients between the ages of 0 and 22 years needed to meet specific criteria: mild symptoms and either known exposure, high-risk status, family member with high-risk status or required testing for work. Physicians referred patients through an online portal that collected basic demographic information, reported symptoms and the reason for referral.

When Dr. Goyal and her colleagues analyzed the data from the first 1,000 patients tested at this site, they found that infection rates differed dramatically among different racial and ethnic groups. While about 7% of non-Hispanic white children were positive for COVID-19, about 30% of non-Hispanic Black and 46% of Hispanic children were positive.

“You’re going from about one in 10 non-Hispanic white children to one in three non-Hispanic Black children and one in two Hispanic children. It’s striking,” says Dr. Goyal.

Using data from the American Families Survey, which uses five-year census estimates derived from home address to estimate median family income, the researchers separated the group of 1,000 patients into estimated family income quartiles. They found marked disparities in COVID-19 positivity rates by income levels: while those in the highest quartile had infection rates of about 9%, about 38% of those in the lowest quartile were infected.

There were additional disparities in exposure status, Dr. Goyal adds. Of the 10% of patients who reported known exposure to COVID-19, about 11% of these were non-Hispanic white. However, non-Hispanic Black children were triple this number.

Although these numbers show clear disparities in COVID-19 infection rates, the authors are now trying to understand why these disparities occur and how they can be mitigated.

“Some possible reasons may be socioeconomic factors that increase exposure, differences in access to health care and resources, as well as structural racism,” says Dr. Goyal.

She adds that Children’s National is working to address those factors that might increase risk for COVID-19 infection and poor outcomes by helping to identify unmet needs — such as food and/or housing insecurity — and steer patients toward resources when patients receive their test results.

“As clinicians and researchers at Children’s National, we pride ourselves on not only being a top-tier research institution that provides cutting-edge care to children, but by being a hospital that cares about the community we serve,” says Denice Cora-Bramble, M.D., M.B.A., chief medical officer of Ambulatory and Community Health Services at Children’s National and the research study’s senior author. “There’s still so much work to be done to achieve health equity for children.”

Other Children’s National researchers who contributed to this study include Joelle N. Simpson, M.D.; Meleah D. Boyle, M.P.H, Gia M. Badolato, M.P.H; Meghan Delaney, D.O,. M.P.H.; and Robert McCarter Jr., Sc.D.

Staphylococcus

Airway microbial diversity in children with Cystic Fibrosis

Staphylococcus

Despite having less overall microbial richness, children with Cystic Fibrosis displayed a greater presence of Staphylococcus species.

Cystic Fibrosis (CF) is a disease that mainly affects the lungs and arises from mutations in the cystic fibrosis transmembrane conductance regulator (CFTR) gene that encodes for the CFTR membrane protein located on certain secretory cells. CFTR dysfunction leads to complications such as the production of abnormally viscous mucus which causes chronic suppurative lung infections that require antibiotics to treat. New drugs called CFTR modulators can help improve CFTR protein function and some are even FDA-approved for use in children. In addition to CFTR protein function, the lung’s resident microbiota and its richness of diversity, plays an important role in both health and disease, including CF.

In a new study published in Heliyon, scientists from Children’s National Hospital examined the difference in the upper airway microbiome between children with CF and healthy controls. Age-related differences among children with CF and the impact of CFTR modulators on microbial diversity were also assessed. Seventy-five children between 0-6 years of age participated in the study, including 25 children with CF and 50 healthy controls. For CF participants, oropharyngeal swabs and clinical data were obtained from the biorepository, while data for controls were obtained during a single clinical visit.

Analysis revealed that CF patients had less microbial diversity and different composition of the upper airway microbiome compared to age similar controls, a finding that is consistent with research on the lower airways. Despite having less overall microbial richness, children with CF displayed a greater presence of Staphylococcus species, (a main driver of the pulmonary exacerbations characteristic of CF), three Rothia operational taxonomic units (OTUs) and two Streptococcus OTUs. CF patients received a significantly higher number of antibiotics courses within the previous year compared to healthy controls, and further investigation will be necessary to understand the impact of antibiotics on the upper airway microbiome of infants and children with CF.

Longitudinal comparisons to study effects of age and CFTR modulation on the microbiome of children with CF were also undertaken. Younger CF patients (those 0 to <3 years of age at study enrollment), were more likely to have culturally-normal respiratory flora and more stable microbial composition over time than older CF patients (those ≥ 3–6 years of age at study enrollment), with no significant differences in alpha or beta diversity. Older CF patients were significantly more likely to be receiving a CFTR modulator than younger patients. CF patients receiving CFTR modulators had higher microbial diversity measures than those not receiving CFTR modulators and were closer (but still significantly lower) in microbial richness to healthy controls. No significant differences in beta diversity were found between the three groups.

This study adds to the growing body of evidentiary support for the use of CFTR modulators in improving airway microbial diversity in CF patients. Future studies with a larger cohort and greater focus on the impact on early initiation of CFTR modulators on microbial diversity and clinical outcomes is necessary.

The study, “Airway microbial diversity is decreased in young children with cystic fibrosis compared to healthy controls but improved with CFTR modulation,” was recently published in Heliyon. The lead author is Andrea Hahn, M.D., M.S., an investigator at the Children’s National Research Institute. Notable authors include Aszia Burrell; Emily Ansusinha; Hollis Chaney, M.D.; Iman Sami, M.D.; Geovanny F. Perez, M.D.; Anastassios C. Koumbourlis, M.D., M.P.H.; Robert McCarter, Sc.D.; and Robert J. Freishtat, M.D., M.P.H..

Catherine Limperopoulous

The brain’s fluid-filled spaces during growth

Catherine Limperopoulous

Catherine Limperopoulous, Ph.D., and her colleagues used volumetric MRIs to assess how the ventricles, cerebrospinal fluid and the rest of the fetal brain normally change over time.

The human brain is not one solid mass. Buried within its gray and white matter are a series of four interconnected chambers, called ventricles, which produce cerebrospinal fluid. These ventricles are readily apparent on the fetal ultrasounds that have become the standard of prenatal care in the United States and most developed countries around the world. Abnormalities in the ventricles’ size or shape – or both – can give doctors an early warning that fetal brain development might be going awry.

But what is abnormal? It is not always clear, says Catherine Limperopoulos, Ph.D., director of the Developing Brain Research Laboratory at Children’s National Health System. Limperopoulos explains that despite having many variations in fetal ventricles, some infants have completely normal neurodevelopmental outcomes later. On the other hand, some extremely subtle variations in shape and size can signal problems.

On top of these complications are the tools clinicians typically use to assess the ventricles. Limperopoulos explains that most early indications of ventricle abnormalities come from ultrasounds, but the finer resolution of magnetic resonance imaging (MRI) can provide a more accurate assessment of fetal brain development. Still, both standard MRI and ultrasound provide only two-dimensional pictures, making it difficult to quantify slight differences in the volume of structures.

To help solve these problems, Limperopoulos and her colleagues recently published a paper in Developmental Neuroscience that takes a different tack. The team performed volumetric MRIs – a technique that provides a precise three-dimensional measure of structural volumes – on the brains of healthy fetuses to assess how the ventricles, cerebrospinal fluid and the rest of the brain normally change over time. Limperopoulos’ team recently performed a similar study to assess normal volumetric development in the brain’s solid tissues.

Previous studies published on comparable topics typically used information gathered from subjects who initially had clinical concerns but eventually were dismissed from these studies for not having worrisome diagnoses in the end. This might not truly reflect a typical population of pregnant women, Limperopoulos says.

Working with 166 pregnant women with healthy pregnancies spanning from 18 to 40 weeks gestation, the researchers performed volumetric MRIs on their singleton fetuses that covered every week of this second half of pregnancy. This technique allowed them to precisely calculate the volumes of structures within the fetal brain and get an idea of how these volumes changed over time within the group.

Their results show that over the second and third trimester:

  • The lateral ventricles, the largest ventricles found in the cerebrum with one for each brain hemisphere, grew about two-fold;
  • The third ventricle, found in the forebrain, grew about 23-fold;
  • The fourth ventricle, found in the hindbrain, grew about eight-fold;
  • And the extra-axial cerebrospinal fluid, found under the lining of the brain, increased about 11-fold.

The total brain volume increased 64-fold over this time, with the parenchyma – the solid brain tissue that encompasses gray and white matter – growing significantly faster than the cerebrospinal fluid-filled spaces.

Limperopoulos points out that the ability to measure the growth of the brain’s fluid-filled spaces relative to the surrounding brain tissue can provide critical information to clinicians caring for developing fetuses. In most cases, knowing what is normal allows doctors to reassure pregnant women that their fetus’ growth is on track. Abnormalities in these ratios can provide some of the first signals to alert doctors to blockages in cerebrospinal fluid flow, abnormal development, or the loss of brain tissue to damage or disease. Although the neurodevelopmental outcomes from each of these conditions can vary significantly, traditional ultrasounds or MRIs might not be able to distinguish these possibilities from each other. Being able to differentiate why cerebrospinal fluid spaces have abnormal shapes or sizes might allow doctors to better counsel parents, predict neurological outcomes, or potentially intervene before or after birth to mitigate brain damage.

“By developing a better understanding of what’s normal,” Limperopoulos says, “we can eventually identify reliable biomarkers of risk and guide interventions to minimize risks for vulnerable fetuses.”

Setting a baseline for healthy brain development

Catherine Limperopoulos, Ph.D., and colleagues performed the largest magnetic resonance imaging study of normal fetal brains in the second and third trimesters of pregnancy.

Starting as a speck barely visible to the naked eye and ending the in utero phase of its journey at an average weight of 7.5 pounds, the growth of the human fetus is one of the most amazing events in biology. Of all the organs, the fetal brain undergoes one of the most rapid growth trajectories, expanding over 40 weeks from zero to 100 billion neurons — about as many brain cells as there are stars in the Milky Way Galaxy.

This exponential growth is part of what gives humans our unique abilities to use language or have abstract thoughts, among many other cognitive skills. It also leaves the brain extremely vulnerable should disruptions occur during fetal development. Any veering off the developmental plan can lead to a cascade of results that have long-lasting repercussions. For example, studies have shown that placental insufficiency, or the inability of the placenta to supply the fetus with oxygen and nutrients in utero, is associated with attention deficit hyperactivity disorder, autism, and schizophrenia.

Recent research has identified differences in the brains of people with these disorders compared with those without. Despite the almost certain start of these conditions within the womb, they have remained impossible to diagnose until children begin to show clinical symptoms. If only researchers could spot the beginnings of these problems early in development, says Children’s National Health System researcher Catherine Limperopoulos, Ph.D., they might someday be able to develop interventions that could turn the fetal brain back toward a healthy developmental trajectory.

“Conventional tools like ultrasound and magnetic resonance imaging (MRI) can identify structural brain abnormalities connected to these problems, but by the time these differences become apparent, the damage already has been done,” Limperopoulos says. “Our goal is to be able to pick up very early deviations from normal in the high-risk pregnancy before an injury to the fetus might become permanent.”

Before scientists can recognize abnormal, she adds, they first need to understand what normal looks like.

In a new study published in Cerebral Cortex, Limperopoulos and colleagues begin to tackle this question through the largest MRI study of normal fetal brains in the second and third trimesters of pregnancy. While other studies have attempted to track normal fetal brain growth, that research has not involved nearly as many subjects and typically relied on data collected when fetuses were referred for MRIs for a suspected problem. When the suspected abnormality was ruled out by the scan, these “quasi-controls” were considered “normal” — even though they may be at risk for problems later in life, Limperopoulos explains.

By contrast, the study she led recruited 166 healthy pregnant women from nearby low-risk obstetrics practices. Each woman had an unremarkable singleton pregnancy and ended up having a normal full-term delivery, with no evidence of problems affecting either the mother or fetus over the course of 40 weeks.

At least one time between 18 and 39 gestational weeks, the fetuses carried by these women underwent an MRI scan of their brains. The research team developed complex algorithms to account for movement (since neither the mothers nor their fetuses were sedated during scans) and to convert the two-dimensional images into three dimensions. They used the information from these scans to measure the increasing volumes of the cerebellum, an area of the brain connected to motor control and known to mediate cognitive skills; as well as regions of the cerebrum, the bulk of the brain, that is pivotal for movement, sensory processing, olfaction, language, and learning and memory.

Their results in uncomplicated, full-term pregnancies show that over 21 weeks in the second half of pregnancy, the cerebellum undergoes an astounding 34-fold increase in size. In the cerebrum, the fetal white matter, which connects various brain regions, grows 22-fold. The cortical gray matter, key to many of cerebrum’s functions, grows 21-fold. And the deep subcortical structures (thalamus and basal ganglia), important for relaying sensory information and coordination of movement and behavior, grow 10-fold. Additional examination showed that the left hemisphere has a larger volume than the right hemisphere early in development, but sizes of the left and right brain halves were equal by birth.

By developing similar datasets on high-risk pregnancies or births—for example, those in which fetuses are diagnosed with a problem in utero, mothers experience a significant health problem during pregnancy, babies are born prematurely, or fetuses have a sibling diagnosed with a health problem with genetic risk, such as autism—Limperopoulos says that researchers might be able to spot differences during gestation and post-natal development that lead to conditions such as schizophrenia, attention deficit hyperactivity disorder and autism spectrum disorder.

Eventually, researchers may be able to develop fixes so that babies grow up without life-long developmental issues.

“Understanding ‘normal’ is really opening up opportunities for us to begin to precisely pinpoint when things start to veer off track,” Limperopolous says. “Once we do that, opportunities that have been inaccessible will start to present themselves.”

Rheumatic heart disease is a family affair

Parasternal long axis echocardiographic still frames in early systole in black and white and color Doppler of RHD-positive index case, sibling, and mother.

Parasternal long axis echocardiographic still frames in early systole in black and white and color Doppler of RHD-positive index case, sibling, and mother.

Siblings of children in Northern Uganda with latent rheumatic heart disease (RHD) are more likely to have the disease and would benefit from targeted echocardiographic screening to detect RHD before it causes permanent damage to their heart valves, according to an unprecedented family screening study.

RHD results from a cascade of health conditions that begin with untreated group A β-hemolytic streptococcal infection. In 3 percent to 6 percent of cases, repeat strep throat can lead to acute rheumatic fever. Almost half of children who experience acute rheumatic fever later develop chronic scarring of the heart valves, RHD.  RHD affects around 33 million people and occurs most commonly in low-resource environments, thriving in conditions of poverty, poor sanitation, and limited primary healthcare. Treating streptococcal infections can prevent a large percentage of children from developing RHD, but these infections are difficult to diagnose in low-resource settings.

Right now, kids with RHD often are not identified until they reach adolescence, when the damage to their heart valves is advanced and severe cardiac symptoms or complications develop. In such countries, cardiac specialists are rare, and intervention at an advanced stage is typically too expensive or unavailable.  Echocardiographic screening can “see” RHD before symptoms develop and allow for earlier, more affordable, and more practical intervention. A team led by Children’s National Health System clinicians and researchers conducted the first-ever family echocardiographic screening study over three months to help identify optimal strategies to pinpoint the families in Northern Uganda at highest RHD risk.

“Echocardiographic screening has the potential to be a powerful public health strategy to lower the burden of RHD around the world,” says Andrea Beaton, M.D., a cardiologist at Children’s National and the study’s senior author. “Finding the 1 percent of vulnerable children who live in regions where RHD is endemic is a challenge. But detecting these silent illnesses would open the possibility of providing these children monthly penicillin shots – which cost pennies and prevent recurrent streptococcal infections, rheumatic fever, and further valve damage.”

The research team leveraged existing school-based screening data in Northern Uganda’s Gulu District and recruited 60 RHD-positive children and matched them with 67 kids attending the same schools who were similar in age and gender but did not have RHD. After screening more than 1,000 parents, guardians, and first-degree family members, they found that children with RHD were 4.5 times as likely to have a sibling who definitely had RHD.

“Definite RHD was more likely to be found in mothers, with 9.3 percent (10/107 screened) having echocardiographic evidence of definite RHD, compared to fathers 0 percent (0/48 screened, p = 0.03), and siblings 3.3 percent (10/300 screened, p = 0.02),” writes lead author Twalib Aliku, School of Medicine, Gulu University, and colleagues. “There was no increased familial, or sibling risk of RHD in the first-degree relatives of RHD-positive cases (borderline & definite RHD) versus RHD-negative cases. However, RHD-positive cases had a 4.5 times greater chance of having a sibling with definite RHD (p = 0.05) and this risk increased to 5.6 times greater chance if you limited the comparison to RHD-positive cases with definite RHD (n = 30, p = 0.03.”

The paper, “Targeted Echocardiographic Screening for Latent Rheumatic Heart Disease in Northern Uganda,” was published recently by PLoS and is among a dozen papers published this year about the group’s work in Africa, done under the aegis of the Children’s Research Institute global health initiative.

The World Health Organization previously has prioritized screening household contacts when an index case of tuberculosis (TB) is identified, the authors note. Like TB, RHD has a strong environmental component in that family members are exposed to the same poverty, overcrowding, and circulating streptococcal strains. In a country where the median age is 15.5, it is not practical to screen youths without a detailed plan, Dr. Beaton says. Additional work would need to be done to determine which tasks to shift to nurses, who are more plentiful, and how to best leverage portable, hand-held screening machines.

“Optimal implementation strategies, the who, when, in what setting, and how often to screen, have received little study to date, yet these details are critical to developing cost-effective and sustainable screening programs,” Aliku and co-authors write. “Our study suggests that siblings of children identified with latent RHD are a high-risk group, and should be prioritized for screening.”

Related resources:  Research at a Glance

Unlocking the ‘black box’ of NICU monitors to protect vulnerable preemies

MiningdatafromNICUmonitors

What’s Known
Around the world, some 15 million infants are born prematurely each year. Babies born prematurely can spend their first weeks to months of life in the neonatal intensive care unit (NICU) tethered to machines that closely monitor vital signs, such as breathing and heart rate.

After discharge, preemies have a very high risk of returning to the NICU, often due to breathing difficulties, such as experiencing excessively long pauses between breaths. Such acute life-threatening events are a major cause of preemies’ hospital readmission and may result in death.

What’s New
During infants’ NICU stays, cardiorespiratory monitors amass a mountain of data about each child. Through the unprecedented collaboration of researchers working in various divisions of Children’s National Health System, the team was able to unlock that black box of information by creating algorithms to extract data and by using retrospective analyses to tease out new insights. This multidisciplinary team has been able to predict with a greater degree of precision which babies are at higher risk of returning to the NICU after discharge. What these most vulnerable preemies have in common is the degree of maturation of their autonomic nervous system, which controls such involuntary actions as heart rate and breathing. The sympathetic nervous system, which the body leverages as it copes with the stress of life-threatening events (ALTE), also plays a role in these infants’ heightened vulnerability. Being able to identify these newborns earlier has the potential to lower readmissions and save lives.

Questions for Future Research
Q: How can further computer-based analyses of NICU monitor data be used to determine how preemies respond to routine activities, such as feeding to predict which infants have compromised cardiorespiratory systems?
Q: How can we develop a test to assess all premature infants for physiologic readiness for safe NICU discharge and, thus, prevent ALTE and sudden death in this vulnerable population?

Source: “Vagal Hypersensitivity in Premature Infants and Risk of Hospital Readmission Due to Acute Life-Threatening Events (ALTE).” G. Nino, R. Govindan, T. AlShargabi, M. Metzler, R. Joshi, G. Perez, A.N. Massaro, R. McCarter, and A. du Plessis. Presented during the 2016 Pediatric Academic Societies Annual Meeting, Baltimore, MD. May 2, 2016.
Catherine Limperopoulos

Connection between abnormal placenta and impaired growth of fetuses discovered

CLimperopoulous

A team of researchers used 3-D volumetric magnetic resonance imaging (MRI) in an innovative study that reported that when the placenta fails to grow adequately in a fetus with congenital heart disease (CHD), it contributes to impaired fetal growth and premature birth. Fetal CHD involves an abnormality of the heart and is associated with increased risk for neurodevelopmental morbidity.Until now, CHD in the fetus and its relationship to placental function has been unknown. But the advanced fetal imaging study has shown for the first time that abnormal growth in the fetus with CHD relates to impaired placental growth over the third trimester of pregnancy. Catherine Limperopoulos, PhD, Director of Children’s National Developing Brain Research Laboratory in the Division of Diagnostic Imaging and Radiology, is the senior author of the study published in the September 2015 issue of the journal Placenta, “3-D Volumetric MRI Evaluation of the Placenta in Fetuses With Complex Heart Disease.”

Specifically, the decreased 3-D volumetric MRI measurements of pregnant women reported in this study suggest placental insufficiency related to CHD. The placenta nourishes and maintains the fetus, through the delivery of food and oxygen. Its volume and weight can determine fetal growth and birth weight.

Abnormality in placental development may contribute to significant morbidity in this high risk-population. This study shows impaired placental growth in CHD fetuses is associated with the length of the pregnancy and weight at birth. Nearly 1 in every 100 babies is born in the United States with a congenital heart defect.

Developing the capacity to examine the placenta non-invasively using advanced MRI is needed to identify early markers of impaired placental structure and function in the high-risk pregnancy. This is a critical first step towards developing strategies for improved fetal monitoring and management, Dr. Limperopoulos says.

“We are trying to develop the earliest and most reliable indicators of placental health and disease in high-risk pregnancies. Our goal is to bring these early biomarkers into clinical practice and improve our ability to identify placental dysfunction,” Dr. Limperopoulos says. “If we can develop the capacity to reliably identify when things begin to veer off course, we then have a window of opportunity to develop therapies to restore function.”

The study used in-vivo 3-D MRI studies and explored placental development and its relationship to neonatal outcomes by comparing placental volumetric growth in healthy pregnancies and pregnancies complicated by CHD.

While mortality rates continue to decrease steadily in newborns diagnosed with complex CHD, long-term neurodevelopmental impairments are recognized with increasing frequency in surviving infants, Dr. Limperopoulos says.

“Our goal is to better support the developing fetus with CHD. We can best accomplish this if we develop technology that can allow us to safely and effectively monitor the fetal-placental unit as a whole throughout pregnancy,” Dr. Limperopoulos says.

“This is the new frontier, not only to ensure survival but to safeguard the fetus and to ensure the best possible quality of life,” she says.