Evaluation of the neonatal brain greatly differs from the practice of pediatric and adult neurology.
Recognizing this, the Division of Neonatology and the Division of Neurology at Children’s National Health System came together in 2004 to develop a dedicated Neonatal Neurology and Neurocritical Care program. The program offers access to neonatal neurologists who regularly monitor babies’ developmental progress and perform research in all areas of brain injury prevention and management.
The Division of Neonatology includes the Washington, DC, metropolitan region’s only Level IV Neonatal Intensive Care Unit (NICU) with 54 beds that serves a referral area that spans 47 regional hospitals.
The Neonatal Neurology and Neurocritical Care Program at Children’s National is the only one of its kind in the mid-Atlantic region and a leader in advancing neurologic care to some of the most critically ill newborns. There are only about a dozen or so similar programs in the nation.
Our program consists of a multi-disciplinary team of neonatal neurologists/neurointensivists, neonatologists, pediatric epileptologists, pediatric neuroradiologists and pediatric neurosurgeons and physiatrist as well as fetal neurologists and fetal medicine specialists.
"We are one of only a handful of programs nationally that have neonatal neurologists working in the NICU in both clinical and research capacities," said Billie Short, MD, Chief of the Division of Neonatology. "Our goal is to provide the latest treatments while also developing experimental therapies that we can move from the bench to the bedside, allowing us to significantly improve neonatal and pediatric neurological outcomes."
Specialized Care for Our Youngest Patients
Evaluation and management of neonatal issues include:
- Hypoxic ischemic encephalopathy (HIE)
- Neonatal encephalopathy
- Brain injury
- Cerebral dysgenesis and malformations
- Hypotonia arthrogryposis
- Neuromuscular disorders
- Perinatal stroke and neurogenetic disorders
The Division of Neonatology not only employs advanced technology in the NICU, but also is at the forefront of technological developments that are revolutionizing the tools used nationwide to monitor neonatal blood flow in the brain and intestines. This includes near-infrared spectroscopy, which is utilized to help pinpoint infants who have the highest risk of developing necrotizing colitis. Researchers at Children’s National also are working to optimize the size and design of equipment used during extracorporeal membrane oxygenation (ECMO).
Neurodiagnostic studies include remote continuous video EEG monitoring, portable CT scanner and neonatal MRI imaging protocols. Neurotherapeutic protocols include therapeutic hypothermia (whole body cooling) for hypoxic ischemic encephalopathy, status epilepticus, neonatal seizures and epilepsy, and perinatal strokes. Clinical trials are ongoing.
The Neonatal Neurology Program and Neurocritical Care Program provides both Neonatal Neurology and Perinatal Brain Injury clinics for evaluation and ongoing care of newborns and infants with neurologic issues acquired in the neonatal period at both the Sheikh Zayed Campus for Advanced Children’s Medicine and the Pediatric Specialists of Virginia.
The Perinatal Brain Injury Clinic is a joint multidisciplinary clinic with neonatal neurology, pediatric rehabilitation medicine and physical therapy for our neurologic patients with cerebral palsy.
The Biomarker-Brain Injury Link
Ongoing research at Children’s National is identifying biomarkers, such as heart rate variability, that may help determine the extent of brain injury before, during, and after whole-body hypothermia, the gold standard of treatment for perinatal hypoxic ischemic encephalopathy.
"Approximately half of infants with HIE experience poor outcomes following hypothermia," said An Massaro, MD, Co-director of Research for the Division of Neonatology. "We hope to identify a method of routine monitoring to determine which patients are failing treatment. If we can pinpoint biomarkers that are early signs of impending injury, such as pattern changes in heart rate, we can intervene before the patient is compromised."
Using heart rate variability, researchers also hope to better diagnose brain injury and give parents an accurate glimpse at their child’s future neurological outcome.
"No newborn walks or talks, so the challenge in predicting outcomes involves evaluating an area of the brain that currently is not in use," said Taeun Chang, MD, Director of the Neonatal Neurology and Neurocritical Care Program. “However, all infants know how to breathe, sleep, and regulate their heart rate and temperature. Through our research, we’ve developed mathematical analyses to evaluate heart rate variability. Lack of heart rate variability indicates brain injury."
Placenta’s Role in Brain Injury
Premature birth and placental infection are major contributors to neonatal brain injuries. Fostering a greater understanding of the placental hormones and growth factors present in the normal fetal environment may help physicians develop targeted therapies that prevent brain injury.
"The placenta is naturally optimized to aid brain development," said Anna Penn, MD, PhD, investigator in the Center for Neuroscience Research and Co-director of the Board of Visitors Cerebral Palsy Prevention Program in the Division of Neonatology. "At this time, we don’t know how the hormones and growth factors released by the placenta influence fetal brain development. My goal is to gain greater understanding of what’s happening at a basic scientific level so we can create a cocktail of synthetic hormones that help normalize brain development following placental infection or premature birth."
Dr. Penn’s prior placental research has included monitoring hormone levels in mouse models, examining human placentas to see what hormones are produced under certain circumstances, and analyzing the cerebral spinal fluid of premature infants to see which hormones are present. Her ongoing research in both babies and mice focuses on determining which fetal and newborn hormone levels correlate with normal development and improved neurological outcomes when there is risk of brain injury.
Clinical Training and Other Learning Opportunities
Our training programs offer top-notch medical education and experience complementing our commitment to excellence. Residents and Fellows participate in a rigorous curriculum providing many research, conference and learning opportunities such as our Child Neurology Fellowship and our Fetal Neurology Research Fellowship Program headed by Adré J du Plessis, MBChB, Director of the Fetal Medicine Institute at Children's National.