Development and Functioning of Very Low Birth Weight Infants from Infancy to School Age (PIPARI)
Principal Investigator: LIISA LEHTONEN
Researchers: Helena Lapinleimu, Leena Haataja, Eeva Ekholm, Pentti Kero, Jarkko Kirjavainen, Harry Kujari, Hanna Manninen, Pertti Palo, Riitta Parkkola, Jorma Piha, Päivi Rautava, Hellevi Rikalainen, Elina Savonlahti, Matti Sillanpää, Tuula Äärimaa, Riikka Korja, Jonna Maunu, Petriina Munck, Annika Pihlgren, Milla Reiman, Suvi Stolt
Department of Pediatrics, Turku University Hospital
The brain of a preterm infant is prone to injuries due to prematurity itself and due to treatments needed to sustain the vital functions. The final functional outcome of a preterm infant prone to these biological injuries is strongly modified by later environmental factors. Research of mechanisms causing and compensating these injuries opens an interesting view into brain development.
Very preterm infants (<32 weeks of gestation or birth weight <1501 g) are in the highest risk for later developmental problems. Centralized care of very preterm infants provides a solid foundation for our multidisciplinary long-term follow-up study which was started in 2001 for very preterm infants born in Turku University Hospital (60 infants per year for 6 years = a total of 300 very preterm infants). We follow the study patients using standardized methods starting from fetal assessments and ending up to the functional outcome at school-age. The end point is at school age to be able to evaluate the real-life functional outcome in the challenging school environment. Successful functioning at school is a sum of different skills and abilities. We have coordinated different approaches to get a full picture of the outcome, the risk factors for later functional deficits and also to find early diagnostic features of an abnormal development in preterm infants.
First of our focuses is the processes leading to brain injury during fetal life. These harmful processes include antenatal alcohol exposure, insufficient blood perfusion to the critical brain regions or inflammatory processes shown to be a common cause for a preterm delivery. In addition to the environmental inflammation provoking factors, there are differences in the genetic predisposition to mount inflammation. In addition, the strategies chosen in the neonatal intensive care affect the developing brain, which is reflected in a large center-to-center variation in the proportion of preterm infants suffering from severe disabilities and also in yearly trends within a center. We will also evaluate new quantitative brain imaging techniques assessing regional brain volumes to find better predictive tools to screen the infants with later neuropsychological problems.
The development of the child is also significantly influenced by social and other environmental factors. The quality of early parent-child interaction has a central role in the overall development of a child. We assess to influence of preterm birth on mother-infant interaction and the protective components as well as the risk factors for later functional outcome.
Multidisciplinary clinical research with a long follow-up is necessary to learn to understand the causes and compensating mechanisms of brain injuries related to prematurity. Our aim is also to find early diagnostic predictors of abnormal development to focus the follow-up and rehabilitation in a cost-effective way for those who benefit of it most. Understanding the primary origins of injuries and the potential ways to support the compensating mechanisms of the developing brain are crucial to improve the care and to achieve better developmental outcomes. The final goal is to learn to use treatments preventing brain injuries, and when this is not possible, to maximize the recruitment the compensatory mechanisms of the brain.
Contact: liisa.lehtonen(at)utu.fi, tel.: +358 2 3130 253