CHOC neonatologist Dr. Terrie Inder, an expert on the newborn brain, is the lead author of an authoritative review paper published in the New England Journal of Medicine (NEJM). Dr. Inder’s “Defining the Neurological Consequences of Preterm Birth,” appears in the Aug. 3, 2023, issue of the NEJM, a leading global medical journal.
Director of the Center for Neonatal Research at CHOC, Dr. Inder wrote the comprehensive review with a mentor and longtime collaborator, Dr. Joseph J. Volpe, a founder of neonatal neurology with his seminal book, Neurology of the Newborn, and Peter J. Anderson, Ph.D., another research partner of Dr. Inder who is affiliated with Boston Children’s Hospital.
Review articles that appear in the NEJM are considered specialty-defining works that will be cited by thousands of researchers moving forward.
Experts on the newborn brain will build on the conclusions of Dr. Inder’s paper, which focuses on brain injuries and long-term adverse neurologic effects of preterm babies (those born after less than 37 weeks’ gestation) and very preterm children (those born between 32 weeks and 26 weeks).
“This is the new authoritative text on the neurological consequences of pre-term birth,” said Dr. John Crawford, medical director of neurology at CHOC and co-medical director of the CHOC Neuroscience Institute. “We have one of the world’s leading experts on neonatal brain injury right here in Orange County.”
Dr. Inder, who joined CHOC in summer 2022 after being recruited from Brigham and Women’s Hospital, a major teaching hospital at Harvard Medical School, provides in the paper a comprehensive overview of what is known about the neurological consequences of pre-term birth and highlights gaps in current knowledge.
“CHOC is thrilled to be leading in this area of science and I am humbled to be recognized by having leading authorship on the review of this topic,” said Dr. Inder, a dual-boarded neonatologist and child neurologist who is a professor of pediatrics in UC Irvine’s Department of Pediatrics, which is chaired by CHOC Senior Vice President and Pediatrician-in-Chief Dr. Coleen Cunningham.
“Dr. Inder is a world leader in this field and we are delighted to have her here at CHOC and UCI,” Dr. Cunningham said.
The last time a review article on a similar subject was published in the NEJM was about a decade ago, Dr. Inder said.
Injuries and development
Globally, an estimated 15 million infants are born preterm (between 37- and 32-weeks’ gestation).
Despite advances in healthcare that are keeping more of these, as well as very preterm infants, alive, the risk of long-term neurological and developmental disabilities remains high, the NEJM paper concludes.
Dr. Inder and her colleagues detail how the immature brain is vulnerable to three types of brain injuries: those affecting the white matter, germinal matric-intraventricular hemorrhage, and cerebellar hemorrhage.
“We know these brain injuries occur commonly, although they are often unrecognized without magnetic resonance imaging (MRI) scans of the infant’s brain,” said Dr. Inder. “We’re still working on preventative strategies and remediating these injuries from having adverse neurological outcomes in later life through rehabilitation.”
In addition to these three injuries, a preterm infant’s time spent in the neonatal intensive care unit (NICU) can influence brain development with neurological consequences – for example, being cared for in an environment with lights, noises, and smells.
Other important factors include nutrition and nurturing, such as parent voice and touch/holding. There are also influences after discharge such as rehabilitation therapies and family care.
“An understanding of these factors will assist neonatal clinicians in using future neuroprotective strategies to improve long-term neurological outcomes in the preterm infant,” Dr. Inder and her colleagues write.
Second appearance in NEJM
The review article is Dr. Inder’s second appearance in the NEJM. In 2006, she and Dr. Anderson had a study published in the journal. Together, they now have co-authored 78 papers in various publications.
Dr. Inder has published often with Dr Volpe and has joined him as a co-editor of Neurology of the Newborn, the leading text in the field.
Competitive and high-impact medical journals such as the NEJM, which has published continuously for more than 200 years, accepts only the top 1% of research submissions received each year.
“Dr. Inder has spent a large part of her career looking at MRIs to track the development of injuries and how the brain develops in preterm infants, and her new NEJM paper is a distillation of this lifetime work,” Dr. Crawford said.
“While this is also a review article of others’ work, Dr. Inder, Dr. Volpe and Dr. Anderson have significantly contributed to the literature and background studies that are the basis of this review article,” he added.
“This paper provides a very comprehensive study of what we know about the neurological consequences of preterm birth and also highlights our gaps and our knowledge in this area and paves the way for future studies,” Dr. Crawford said. “There’s still much work to be done, as this paper so eloquently describes.”
“These are children that have the potential of living 70, 80, 90 years, and we should be investing in making sure they have the best possible outcomes.”
Such an effort, Dr. Crawford noted, will take teamwork.
“It really requires a collaboration between neonatologists, child neurologists, and neuropsychologists,” he said. “It really spans a whole spectrum of disciplines to care for these children.”
Added Dr. Inder: “We shouldn’t be focusing on the just the survival of these babies, but on optimizing their long-term neurological health. This is also our mission at CHOC with ‘Long Live Childhood.’”