Breast milk boosts brain development in premature babies

 

The more breast milk premature babies are fed while in neonatal intensive care, the greater the level of brain development, a study suggests. The cerebral cortex – the part of the brain for learning and thinking – is usually underdeveloped in premature babies, but in infants who consumed high levels of breast milk it quickly resembled those of babies born to term. Experts say that feeding premature babies with breast milk could help reduce the developmental and learning problems associated with preterm birth. Every year, 15 million children worldwide are born pre-term - before 37 weeks - and it is still the biggest cause of death and disability among newborn babies. Children who are born early are more likely to develop problems that affect their entire lives such as learning difficulties, problems with their sight and hearing, behavioural issues and cerebral palsy. Researchers from University of Edinburgh scanned the brains of 212 babies who were part of the Theirworld Edinburgh Birth Cohort, a study which monitors the progress of premature babies from birth to adulthood. The group included 135 babies who were born before 32 weeks of pregnancy and 77 who were born to term. Researchers collected information about how premature babies were fed during neonatal intensive care and brain scans for all babies were performed around 40 weeks from conception. Brain scans revealed that babies who received higher amounts of breast milk – from their mother or a donor - had a more mature cerebral cortex compared with those who received less, similar to the scans of babies born to term. Breast milk contains many elements – such as a favourable balance of fats, proteins and minerals, and a range of other beneficial factors that help babies' immunity – that could support brain development, experts say. Further research is needed to understand their exact role in allowing premature babies’ brains to catch up with the development seen in term babies. The findings have been published in the Annals of Neurology: https://onlinelibrary.wiley.com/doi/10.1002/ana.26559. The work was funded by Theirworld and took place at the Jennifer Brown Research Laboratory in the Medical Research Council Centre for Reproductive Health at the University of Edinburgh and the Simpson’s Centre for Reproductive Health at the Royal Infirmary of Edinburgh. The Jennifer Brown Research Laboratory was set up in 2004 at the University of Edinburgh as a pioneering project of Theirworld, the global children's charity. It works to better identify women at risk of premature birth, explore the development of treatments to prevent early labour and research how to better help newborn babies in the first hours and days after birth. Dr Gemma Sullivan, Senior Clinical Lecturer in Neonatal Neuroscience at the University of Edinburgh’s MRC Centre for Reproductive Health and a Consultant Neonatologist at NHS Lothian, said: “Our findings suggest that brain development in the weeks after preterm birth is improved in babies who receive greater amounts of breast milk. Mothers of preterm babies should be supported to express breast milk, if they are able to, whilst their baby is in the neonatal unit as this may offer the best chance of healthy brain development.” Sarah Brown, Chair of Theirworld, said: “The research and discoveries from the Theirworld Edinburgh Birth Cohort are truly remarkable. This world-first study is equipping scientists and doctors with valuable information that is expanding the frontiers of medical science and improving the life chances of premature babies. "I will forever be grateful to the families participating in the study who are dedicated to sharing information about their own babies, helping to give other premature babies the best start in life."

Study shows that opioids may affect how we perceive ‘cuteness’ of babies

A new pilot study has found that opioid dependence – which includes dependence on drugs such as heroin – affects how ‘cute’ we perceive images of children to be. As cuteness can trigger caregiving motivation, this result indicates that the opioid system may have significant effects on our ability to care for others. The implications of this may need to be considered in any consideration of medical or recreational opioid use.

Addiction to opioids – which includes illicit drugs such as heroin as well as medications commonly prescribed for pain - affects over 4 million people in the USA. It is associated with reduced responses to natural rewards as well as abnormal social behaviour, such as crime and dysfunctional parenting. Now a group of US researchers is using our normal response to the ‘cuteness’ of babies, (a concept first described by the famous Austrian ethologist Konrad Lorenz as Kindchenschema) to experimentally test the effects of social cognition in individuals with opioid addiction.

Baby schema is a set of visual characteristics typical of human and animal babies, which makes them more adorable or “cute’. They include such features as large eyes, big foreheads, and small chins, which over evolution we have come to subconsciously recognise as characteristic of infants and inviting caretaking, so much so that we have incorporated these features into dolls, cartoon characters, adverts, and even car design, etc.

Earlier research by researchers at the Universities of Pennsylvania (US) and Muenster (Germany) showed that response to baby portraits produces motivation for caretaking and a response in the area of the brain associated with reward proportionate to the Kindchenschema content of the portraits (Glocker, et al, Proceedings of the National Academy of Sciences of the USA, 2009 and Glocker, et al, Ethology 2009: see below for full citation and acknowledgement for image rights).

                                                          

Features altered to change baby schema to ‘increasing cuteness’*

Professors Daniel Langleben, An-Li Wang and their team of the University of Pennsylvania hypothesized that chronic opioid abuse may affect the brain response to baby schema.  They recruited 47 opioid- dependent adults who were starting treatment with an opioid blocker naltrexone and measured how they responded to the baby schema task while recording their brain activity using an fMRI (functional Magnetic Resonance Imaging) scanner, before and after 10 days of treatment with naltrexone.

According to Professor Daniel Langleben:

“We found that the brains of people with opioid dependence didn’t respond to the baby schema. When they were given a drug that blocked the effects of opioids, the response became more similar to the healthy people. This may indicate the mechanism underlying problems with social cognition deficits in people who abuse opioids.

In summary, treatment with opioid modulators seems to be changing the brain response to baby schema and may modulate our motivation to care for others. Our data also raise the question whether opioid medications may affect social cognition in general. Depending on the clinical context such effect could be either desirable or not. Opioids are some of the most common medications in the world, often taken on a long term basis, so this is something to consider”.

This research was funded by the NIH and the University of Pennsylvania

Preterm babies with low birth weight may be at increased risk of osteoporosis

Adults who were born prematurely or at a below average weight are more likely to have weaker bones and an increased risk of fracture and osteoporosis later in life. This research, presented at the European Congress of Endocrinology, could lead to recommendations that high-risk individuals follow diets rich in calcium, vitamin D and protein, and undertake weight-bearing exercise. 

Worldwide, approximately 10% of babies are born preterm and are subject to multiple health risks later in life. The human body concentrates calcium for bone development during the third trimester of pregnancy; if this is interrupted due to premature birth, babies may risk suffering poor bone health later in life. 

This study by researchers at the Norwegian University of Science and Technology examined the bone mass of 186 adults, of both genders.  Peak bone mass is achieved between 20 and 30 years of age and is a good indicator of fracture risk; the sample was therefore made up of adults of 26-28 years of age. Of these 186 individuals, 52 were born prematurely with very low birth weight (1265g) and 59 were born at term but with low birth weight (2950g). The further 75 – who were born at term with average birth weight (3700g) – formed a control group. 

The researchers found that both low birth weight groups had a lower peak bone mass than controls. However, once height – a factor which greatly influences bone mass – was adjusted for, this lower bone mass was accounted for in the group born at term; the research showed that low bone mass in this group was partly due to smaller body size. This was not the case in the preterm, very low birth weight group where body size alone could not account for the low bone mass, highlighting this group as particularly high risk. Differences in physical activity and calcium intake were also adjusted for, and differences in bone mass between groups still persisted. Smoking habits did not differ between the groups, and the occurrence of previous fractures was also similar.

Dr Chandima Balasuriya, who led the study, states that follow-up of these children is important. “Ensuring children with low birth weight have a diet rich in calcium, vitamin D and protein, in combination with exercise regimes involving weight-bearing physical activities, will help reduce risk of bone fractures later in life.”

The next stage for the research will be to look at what causes babies to be born with low birth weights. “We want to examine the ultrasounds to determine whether low birth weight babies are genetically programmed to be smaller, or if it might be a result of growth restriction. We are also analysing mothers’ blood to see how vitamin A and D status might relate to their children’s bone health,” said Dr Balasuriya.  

Babies' susceptibility to colds linked to immune response at birth

Innate differences in immunity can be detected at birth, according to new research at Washington University School of Medicine in St. Louis. And babies with a better innate response to viruses have fewer respiratory illnesses in the first year of life. "Viral respiratory infections are common during childhood," says first author Kaharu Sumino, MD, assistant professor of medicine. "Usually they are mild, but there's a wide range of responses -- from regular cold symptoms to severe lung infections and even, in rare instances, death. We wanted to look at whether the innate immune response -- the response to viruses that you're born with -- has any effect on the risk of getting respiratory infections during the baby's first year."

Reporting in the May issue of the Journal of Allergy and Clinical Immunology, Sumino and her colleagues found that newborns with a diminished immune response to viruses experienced more respiratory infections in their first year of life than newborns whose immune response was more robust.

Using umbilical cord blood samples taken in the delivery room, the researchers measured a specific immune system response to viral infection known as interferon-gamma (IFN-gamma). IFN-gamma is released by some cells of the immune system when they encounter a virus. An important weapon in the immune system's arsenal, IFN-gamma helps fight viruses by stopping them from replicating.

The researchers studied cord blood samples from 82 babies in St. Louis enrolled in the Urban Environment and Childhood Asthma (URECA) trial. Eighty-five percent of the infants were African-American, and all lived in an area where at least 20 percent of the residents were below the poverty level. All had at least one parent with allergies, asthma or eczema, putting them at higher risk for these conditions themselves.

As reported by their caregivers, the babies averaged four colds in their first year with 88 percent of them suffering at least one cold. But the range varied widely with some caregivers reporting no colds and a few reporting as many as nine or 10.

To measure the innate immune response, the blood samples were taken at birth, before any exposure to the environment could influence the child's immunity. The researchers isolated monocytes, a specific type of white blood cell, from the babies' cord blood, and infected these cells with a common respiratory virus. They then measured the amount of IFN-gamma produced by the monocytes in response to the virus.

In general, babies whose monocytes responded to the virus by producing higher levels of IFN-gamma had fewer reported colds. Likewise, babies whose monocytes produced lower IFN-gamma levels had more reported colds.

The scientists also found that newborns whose monocytes produced less IFN-gamma also experienced more ear infections, sinus infections, pneumonia, and hospitalizations due to respiratory illness during their first year. But low IFN-gamma levels were not associated with croup or "stomach flu," indicating that this system may be closely associated with respiratory viruses and not other types of infections.

In an effort to identify other indicators of viral response, the researchers measured amounts of two other immune molecules: chemokine CCL5 and STAT1. Unlike IFN-gamma, neither showed any correlation with the number of illnesses the babies experienced.

This study in infants, as well as research in mice and human cells, supports the idea that dialing up the body's IFN-gamma signaling system may help protect against viral infection. The report's senior author Michael J. Holtzman, MD, the Selma and Herman Seldin Professor of Medicine, is working on drug discovery in this area. Unlike a vaccine, which protects against a specific virus, a drug that improves the body's innate immunity could help fight a broad range of viruses, including the constantly evolving seasonal flu.

"Ideally, if these results are confirmed, we would like to be able to intervene based on knowledge of the innate IFN-gamma response," Sumino says. "We're not there yet -- measuring IFN-gamma levels is complex. But in the future, if we can develop a relatively easy way to find out if someone has a deficiency in this system, we would like to be able to give a drug that can boost the innate immune response."

*Source: Washington University in St. Louis

New pregnancy risk for babies and moms

Pregnant women who are overweight with moderately elevated blood sugar never set off any alarms for their physicians. The big concern was for women who were obese or who had gestational diabetes because those conditions are known to cause a host of health risks to the mom and baby. But a new study shows these women who are just above average for weight and blood sugar are at a higher risk of bad pregnancy outcomes than previously known. In fact, this group is at higher risk than pregnant women who are obese with normal blood sugar or pregnant women who have gestational diabetes and a normal weight.
"These are women who have not been on our radar because they don't have gestational diabetes and aren't obese, but our study shows if you are one step away from each of those, you carry some significant risks," said principle investigator Boyd Metzger, M.D., a professor of medicine-endocrinology at Northwestern University Feinberg School of Medicine and a physician at Northwestern Memorial Hospital. "We need to address the combination of overweight and blood sugar of these women as urgently as we do for women who are obese or have gestational diabetes."
This group of women comprised about 6 percent of the total number of women in the study. Obese women made up 16 percent of the group and those with gestational diabetes accounted for 13.7 percent.
The study also found women who are both obese and have gestational diabetes are at a much higher risk of having an adverse pregnancy than women having only one of those conditions.
The paper, published in the April issue of Diabetes Care, is from the Hyperglycemia and Adverse Pregnancy Outcome (HAPO) Study and includes 23,316 women from nine countries.
One of the adverse outcomes for these mothers is having large babies, the result of fat accumulation. Large babies increase the risk of injury to the baby during vaginal delivery, increasing the likelihood of a Caesarean section.
The study found when the mothers are obese and have gestational diabetes, the babies weigh 340 grams more than babies of mothers with normal weight and blood sugar. When the mothers are overweight (but not obese) with above-average blood sugar levels, the babies weigh 214 grams more. Mothers of normal weight but with gestational diabetes have babies who weigh 164 grams more. And obese mothers with normal glucose levels have babies with an increased weight of 174 grams.
A pregnant woman's higher blood sugar level and weight also can lead to higher insulin and lower blood sugar levels in a newborn. In turn, these effects may eventually trigger obesity and diabetes, perhaps as early as childhood.
"The big message from this is when you look at the impact of nutrition, metabolism and weight on pregnancy outcomes, every woman - on her first prenatal visit -- should get a prescription for a session with a dietician and an appropriate healthy eating plan for her pregnancy," said Metzger, also the Tom D. Spies Professor of Metabolism and Nutrition at Northwestern's Feinberg School. "This doesn't happen, but it should, and insurance companies should reimburse it."

**Source: Northwestern University